Tibial plateau leveling osteotomy surgical site infections: A systematic review with meta-analysis of prevalence and associated risk factors.

Objective

To determine the overall prevalence of surgical site infection (SSI) following tibial plateau leveling osteotomy (TPLO) in dogs and to evaluate associated risk factors across published studies. STUDY

Design

Systematic review with meta-analysis. SAMPLE POPULATION Client-owned dogs that underwent TPLO as described in the published literature.

Methods

A systematic review of studies reporting SSI following TPLO was conducted using PRISMA guidelines. Included studies were screened for quality, and pooled prevalence estimates were calculated using random-effects models. Subgroup and sensitivity analyses were performed. For risk factors, pooled ORs were calculated only when ≥3 comparable studies reported ORs with CIs (weight and postoperative antimicrobial administration).

Results

The meta-analysis included 30 studies encompassing 8820 dogs (9576 TPLOs). Only 5/30 studies were considered level I or II and then further divided into moderate and high level of evidence. The overall SSI rate, including superficial and deep infections, was 9.11% (range: 2.9%-25.9%) and an explant rate of 4.11% (range: 0%-33.36%). Heterogeneity was moderate to high across studies. In pooled analyses limited to comparable studies, postoperative antimicrobial administration was associated with lower odds of SSI, while bodyweight showed minimal association with SSI risk; both findings should be interpreted cautiously given limited comparability across studies.

Conclusion

TPLO SSI rates are higher than other clean orthopedic procedures. Current literature is mostly retrospective in nature. These findings emphasize the need for standardized reporting and infection prevention strategies in clinical practice. CLINICAL

Significance

While higher-quality (higher-level) evidence is needed, trends seen in this large population can be used to start quality control measures in hospitals to reduce TPLO SSI rates.