Predictors of surgical site infection after anterior cervical discectomy and fusion in a national administrative database.

PURPOSE: This study aimed to identify independent predictors of 90-day surgical site infection (SSI) following anterior cervical discectomy and fusion (ACDF). METHODS: A total of 283,947 adult patients who underwent single or multilevel ACDF between 2016 and 2023 were identified from the PearlDiver Mariner database. Demographics, comorbidities, and procedural extent were compared between patients with and without SSI. Multivariable logistic regression identified independent predictors of 90-day SSI. Significance was set at P < 0.05. RESULTS: The overall 90-day SSI incidence was 1.3% (3,815/283,947), with rates of 1.2% after single-level and 1.4% after multilevel fusion. Multilevel surgery increased infection risk (OR 1.22, P < 0.001), while increasing age was associated with lower odds (OR 0.98 per year, P < 0.001). Independent predictors included diabetes (OR 1.22, P < 0.001), obesity (OR 1.52, P < 0.001), anemia (OR 1.76, P < 0.001), fluid/electrolyte disorders (OR 1.90, P < 0.001), peripheral vascular disease (OR 1.28, P < 0.001), essential hypertension (OR 1.26, P < 0.001), depression (OR 1.42, P < 0.001), tobacco use (OR 1.14, P = 0.003), COPD (OR 1.08, P = 0.029), cardiac arrhythmias (OR 1.40, P < 0.001), coagulopathy/hemorrhagic disorders (OR 1.18, P < 0.001), coronary atherosclerosis (OR 1.14, P < 0.001), substance-related disorders (OR 1.28, P < 0.001), and liver disease (OR 1.13, P = 0.002). CONCLUSIONS: SSI after ACDF is rare but more likely among patients with high comorbidity burden and multilevel fusion.