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The impact of obstructive sleep apnea on early surgical site infections in elderly PLIF patients: a retrospective propensity score-matched analysis

Journal of Orthopaedic Surgery and Research volume 20, Article number: 351 (2025) Cite this article

Abstract

Background

Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with intermittent hypoxia, oxidative stress, and systemic inflammation, posing risks for adverse postoperative outcomes, including surgical site infections (SSIs). Elderly patients undergoing posterior lumbar interbody fusion (PLIF) are particularly susceptible to SSIs due to advanced age, comorbidities, and prolonged surgical times. However, the role of OSA in increasing SSI risk among this population remains unclear.

Methods

This retrospective cohort study analyzed 478 elderly PLIF patients from a single institution between May 2016 and June 2024. Of these, 113 were diagnosed with OSA. Propensity score matching (PSM) was performed to balance baseline characteristics, resulting in 83 matched pairs. SSI rates, hospital stays, and readmission rates were compared between the OSA and non-OSA groups. Subgroup analysis was conducted to evaluate the effects of continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) therapy on postoperative outcomes.

Results

After PSM, OSA patients demonstrated a significantly higher SSI incidence (13.3% vs. 3.6%, p = 0.04) compared to non-OSA patients. On multivariate analysis, OSA was the only factor that remained significantly associated with an increased risk of SSIs (Odds Ratio = 4.509, 95% CI: 1.283–21.504, p = 0.03). OSA patients also experienced longer hospital stays (10.1 ± 2.9 vs. 9.1 ± 2.0 days, p = 0.01) and elevated 30-day readmission rates (9.6% vs. 1.2%, p = 0.02). Subgroup analysis revealed that CPAP/APAP therapy reduced SSI incidence (3.9% vs. 17.5%, p = 0.08) and shortened hospital stays (9.1 ± 1.5 vs. 10.5 ± 3.2 days, p = 0.03) among OSA patients.

Conclusion

OSA significantly increases the risk of early SSIs and prolongs hospital stays in elderly PLIF patients. Subgroup analysis suggests that CPAP/APAP therapy may have benefits to OSA patients, though this association requires validation through prospective studies. These findings emphasize the importance of preoperative OSA screening and management to improve surgical outcomes in this high-risk population.

Introduction

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent upper airway obstruction during sleep, resulting in intermittent hypoxia, oxidative stress, and systemic inflammation [1]. Affecting up to 38% of the adult population, OSA is a growing public health concern, particularly in elderly individuals who frequently present with multiple comorbidities [2]. Its consequences extend beyond impaired sleep quality to increased risks of cardiovascular disease, metabolic syndrome, and impaired immune function [3, 4].

Surgical patients with OSA face a heightened risk of adverse perioperative outcomes, including delayed recovery and higher rates of complications such as infections [5, 6]. Postoperative wound healing, a critical determinant of surgical success, is an intricate biological process dependent on adequate oxygenation, collagen synthesis, and a balanced inflammatory response [7, 8]. Intermittent hypoxia associated with OSA disrupts these pathways, potentially impairing tissue repair and increasing susceptibility to surgical site infections (SSIs) [6, 9].

In elderly patients undergoing posterior lumbar interbody fusion (PLIF), a standard procedure for addressing degenerative spinal disorders, the risk of early SSIs is already elevated due to advanced age, prolonged surgical times, and frequent comorbid conditions such as diabetes mellitus and obesity [10,11,12]. The presence of OSA as an additional risk factor may further exacerbate this vulnerability. Despite these concerns, the role of OSA in influencing SSI rates among PLIF patients remains underexplored.

This study aims to evaluate the impact of OSA on postoperative SSI rates in elderly patients undergoing PLIF. By analyzing retrospective cohort data, we seek to determine whether OSA serves as an independent risk factor for SSIs and to highlight the need for targeted perioperative management strategies. Through this investigation, we hope to provide insights into the implications of preoperative OSA screening and management in improving surgical outcomes in this high-risk population.

Methods

Study design and patient selection

This was a retrospective cohort study conducted in our department. Patients aged above 65 years who underwent PLIF during May 2016 to June 2024 were considered for inclusion. Exclusion criteria encompassed prior lumbar spine surgeries, active infections or antibiotic use at the time of surgery, known immunocompromised conditions (such as ongoing chemotherapy, advanced HIV, or chronic corticosteroid therapy), incomplete or missing key data in medical records (absence of essential preoperative variables, missing documentation of OSA diagnosis, or insufficient postoperative follow-up data for SSI assessment). All procedures and methods were approved by the research ethics committee of the college, and informed consent was obtained from all participants. All protocols were conducted in compliance with the ethical principles outlined in the Declaration of Helsinki.

Data collection

Patient data were extracted from electronic medical records, including demographics (age, sex, body mass index), comorbidities (diabetes mellitus, hypertension), smoking status, and American Society of Anesthesiologists (ASA) physical status classification. OSA diagnosis was confirmed through preoperative polysomnography reports or documented clinical diagnoses. Surgical details such as operative time, blood loss, and the use of instrumentation were also recorded.

SSI identification and outcome measures

The identification of SSIs was based on microbiological cultures, operative and hospital records, laboratory reports, and clinical symptoms of infection. Clinical assessments included daily wound inspections by attending surgeons during hospitalization followed by weekly outpatient evaluations until postoperative day 30, with documented criteria requiring either localized signs (erythema extending > 2 cm from incision margins, swelling, tenderness, or purulent discharge) or systemic manifestations (oral temperature > 38.5 °C on consecutive measurements or unexplained C-reactive protein elevation > 50 mg/L). Microbiological confirmation followed stratified protocols: superficial infections required wound swab cultures demonstrating ≥ 105 CFU/mL of pathogenic organisms, while deep/organ-space infections mandated intraoperative tissue cultures or image-guided aspiration specimens, with all culture results interpreted independently by two blinded microbiologists. Centers for Disease Control and Prevention (CDC) criteria application involved a three-tier verification process comprising initial assessment by the surgical team using standardized checklists, secondary validation by infection control specialists, and final adjudication by a senior surgeon for discordant cases, supplemented by contrast-enhanced MRI or CT evidence of abscess formation for deep infections. The primary outcome was the occurrence of SSIs within 30 days postoperatively, classified according to the CDC criteria into superficial incisional, deep incisional, and organ/space infections. Secondary outcomes included length of hospital stay and readmission rates related to SSIs.

CPAP/APAP therapy implementation

CPAP or APAP therapy was prescribed to patients with moderate to severe obstructive sleep apnea (OSA), defined by an apnea-hypopnea index (AHI) ≥ 15 events per hour, or to those with mild OSA (AHI 5–15 events per hour) who had significant symptoms such as daytime sleepiness. Device settings were individualized, with CPAP pressure typically set between 6 and 12 cm H₂O. APAP devices adjusted pressure based on airway resistance within this range. Therapy was initiated at least one week before surgery and continued postoperatively for a minimum of 4 h per night.

Surgical method

All surgeries were performed by the same experienced surgical team. General anesthesia was administered to all patients. The skin incision was made along the posterior median line. Each surgical procedure involved pedicle screw fixation, decompression, lumbar discectomy, and interbody fusion with a bone-filled cage. Prophylactic antibiotics (cefazolin or clindamycin) were administered 30 min prior to surgery, with two additional doses given 24 h postoperatively.

Statistical analysis

Continuous variables were expressed as means with standard deviations and compared using Student’s t-test or Mann-Whitney U test, depending on data distribution. Categorical variables were presented as frequencies and percentages, analyzed using the chi-square test or Fisher’s exact test as appropriate. Propensity score matching (PSM) analysis used the greedy nearest neighbor method for data matching, with ratio = 1:1 and caliper = 0.04. Age, sex, BMI, diabetes mellitus and smoking status were included as confounding variables in the matching process. A p-value of < 0.05 was considered statistically significant.

Results

Study population

A total of 512 elderly patients who underwent PLIF at our department between May 2016 and June 2024 were initially screened for inclusion in this study. After applying the inclusion and exclusion criteria, 478 patients remained eligible for analysis. Of these, 113 patients (23.6%) were diagnosed with OSA and 365 patients (76.4%) did not have OSA.

Since baseline characteristics differed significantly between the OSA and non-OSA groups, propensity score matching (PSM) was applied to balance these characteristics. After PSM, 83 matched pairs of patients were selected from each group for further analysis (Fig. 1).

Fig. 1
figure 1

Flowchart illustrating the patient selection process in this study

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Baseline characteristics before and after propensity score matching

Prior to matching, significant differences were observed between the OSA and non-OSA groups in key baseline characteristics. The OSA group was older, had a higher BMI, exhibited a greater prevalence of diabetes mellitus and had a higher smoking rate compared to the non-OSA group (Table 1). Specifically, the OSA group had a mean age of 74.8 ± 4.7 years, compared to 72.2 ± 4.6 years in the non-OSA group (p < 0.001). And OSA group had a higher BMI than non-OSA group (23.9 ± 2.8 vs. 22.6 ± 2.2, p < 0.001). The OSA group also had a higher proportion of patients with diabetes (52.2% vs. 31.0%, p < 0.001) and smoking rate (55.8% vs. 30.0%, p < 0.001). The incidence of SSIs was 19.5% in the OSA group, compared with 2.7% in the non-OSA group (p < 0.001).

After matching, no significant differences in these baseline variables were observed between the two groups (Table 2). This matching process effectively minimized potential confounding factors, allowing for a more accurate comparison of postoperative outcomes.

Table 1 Characteristics of the patients with and without OSA before propensity score matching
Full size table
Table 2 Characteristics of the patients with and without OSA after propensity score matching
Full size table

Incidence of SSIs

After propensity score matching, the incidence of SSIs remained significantly higher in the OSA group, with 11 patients (13.3%) experiencing SSIs compared to 3 patients (3.6%) in the non-OSA group (p = 0.04). Among the OSA group, 6 patients developed superficial infections compared to 3 in the non-OSA group. Additionally, 4 OSA patients experienced deep incisional infections, while no cases were observed in the non-OSA group. Organ/space infections were reported in 1 OSA patient, whereas none occurred in the non-OSA group (Fig. 2).

Fig. 2
figure 2

Incidence and SSIs in OSA and Non-OSA groups. (A) bar chart comparing the overall incidence of SSIs between the OSA and non-OSA groups. (B) pie chart depicting the distribution of SSI subtypes in the OSA group. (C) pie chart showing the distribution of SSI subtypes in the non-OSA group

Full size image

Multivariate logistic regression analysis for potential risk factors of SSIs

A multivariate logistic regression was performed to evaluate the independent risk factors for SSIs after PSM. The results of the analysis are shown in Table 3. Among the variables assessed, OSA was the only factor that remained significantly associated with an increased risk of SSIs (Odds Ratio = 4.509, 95% CI: 1.283–21.504, p = 0.03), indicating its independent role in SSI development. Other factors, including age, sex, BMI, diabetes mellitus, hypertension, and smoking, were not significantly associated with SSI risk (p > 0.05).

Table 3 Multivariate logistic regression analysis for potential risk factors of SSIs
Full size table

OSA patients exhibit longer hospital stays and higher readmission rates

After propensity score matching, the median length of hospital stay was significantly longer in OSA patients compared to non-OSA patients. The mean hospital stay for OSA patients was 10.1 ± 2.9 days versus 9.1 ± 2.0 days for non-OSA patients (p = 0.01). Additionally, the 30-day readmission rate due to SSIs was notably higher in the OSA group, with 8 patients (9.6%) readmitted compared to 1 patient (1.2%) in the non-OSA group (p = 0.02).

CPAP/APAP therapy reduces SSI incidence and shortens hospital stay in OSA patients

In a subgroup analysis of OSA patients, 26 individuals received continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) therapy. Although there was no statistically significant difference, the incidence of SSIs was lower in the CPAP/APAP group, with only 1 patient (3.9%) developing SSIs compared to 10 (17.5%) in the non-CPAP group (p = 0.08). Furthermore, patients who underwent CPAP/APAP therapy experienced shorter hospital stays, with 9.1 ± 1.5 days compared to 10.5 ± 3.2 days in the non-CPAP group (p = 0.03). Notably, all the 30-day readmission cases occurred in the non-CPAP/APAP group.

Discussion

This study demonstrates a significant association between OSA and an increased incidence of early SSIs in elderly patients undergoing PLIF. Patients with OSA exhibited higher rates of early SSIs, extended hospital stays, and elevated readmission rates compared to their non-OSA counterparts.

OSA increased the risk of early SSIs in elderly PLIF patients

Previous studies have identified OSA as a risk factor for postoperative complications, including infections [13,14,15,16]. For instance, research has indicated that patients with OSA are more likely to develop bacterial pneumonia and exhibit a higher risk of invasive pneumococcal disease [17]. Moreover, a systematic review reported that individuals with OSA had higher rates of wound complications, such as infections and dehiscence, particularly following surgical procedures [16]. These studies support the notion that OSA contributes to adverse postoperative outcomes, consistent with our observations in the PLIF patient population.

OSA is characterized by intermittent hypoxia, which impairs tissue oxygenation and disrupts normal immune responses [9, 18]. Hypoxia leads to endothelial dysfunction [19, 20], altered neutrophil and macrophage activity [21], and delayed collagen synthesis [22]—all of which are critical to wound healing. In our study, the distribution of SSI subtypes revealed that superficial infections were the most common in both groups. Interestingly, deep incisional and organ/space infections were reported only in the OSA group. This pattern may reflect the severity of tissue hypoxia in OSA patients, particularly in deep tissues where oxygen delivery is critical for wound healing. Moreover, the hospital stays and 30-day readmission rate due to SSIs was also markedly higher in the OSA group. These results highlight the clinical and economic implications of untreated OSA in surgical patients, emphasizing the need for enhanced perioperative management and postoperative monitoring strategies.

In addition to the intermittent hypoxia and immune dysregulation previously mentioned, obesity, diabetes, and advanced age contribute significantly to the elevated risk of SSIs observed in OSA patients [23]. Obesity is closely linked to chronic, low-grade inflammation and impaired wound healing, creating an environment conducive to bacterial colonization and infection [24]. Likewise, patients with diabetes exhibit microvascular changes and hyperglycemia-driven immune dysfunction, which further predispose them to surgical site complications [25]. These comorbidities often coexist with OSA, compounding the overall burden of hypoxia-induced oxidative stress and endothelial dysfunction, both of which can exacerbate tissue ischemia and impair leukocyte function. Indeed, our findings align with existing research linking OSA to higher morbidity, underscoring that the management of these overlapping risk factor is vital to mitigating SSI risk.

The role of CPAP/APAP therapy in reducing SSI incidence

Our subgroup analysis revealed that CPAP/APAP therapy may reduce SSI incidence, shortened hospital stays and decrease 30-day readmission rates in OSA patients. By maintaining airway patency and alleviating intermittent hypoxia, CPAP and APAP therapy enhance tissue oxygenation [26], which is essential for regulating the inflammatory response and facilitating wound repair. These findings suggest that preoperative screening for OSA and the implementation of CPAP/APAP therapy may improve postoperative outcomes in PLIF patients.

Clinical implications

The identification of OSA as a significant risk factor for SSIs in PLIF patients has important clinical implications. Given the high prevalence of OSA in elderly patients, routine preoperative screening for OSA should be incorporated into surgical workflows, particularly for elderly patients undergoing PLIF. Early diagnosis and management, particularly with CPAP/APAP therapy, could help reduce the adverse effects of intermittent hypoxia, improve immune function, and lower the risk of infections. Additionally, multidisciplinary perioperative management involving anesthesiologists, surgeons, and sleep specialists is crucial to ensure appropriate interventions for OSA patients [27, 28]. Enhanced recovery protocols that include optimized oxygen delivery, infection control measures, and early mobilization may further improve outcomes in this vulnerable population [29, 30].

Limitations and future directions

Despite the strengths of this study, several limitations should be considered. First, this was a retrospective study, which may introduce inherent biases despite PSM. Second, the study was conducted in a single center, potentially limiting the generalizability of our findings. Third, the sample size for OSA group after PSM and the CPAP/APAP subgroup was relatively small, which may affect the statistical power of the analysis. Future prospective studies should investigate the effects of preoperative CPAP/APAP therapy on SSIs in a larger, multicenter cohort, with a focus on long-term outcomes. Notably, comparative studies investigating the impact of OSA versus chronic obstructive pulmonary disease (COPD) on SSI risk are warranted, as both conditions involve chronic hypoxia but likely differ in perioperative management pathways. Moreover, exploring immune modulation strategies and their role in preventing SSIs in OSA patients may provide additional insights into improving surgical outcomes.

Conclusion

In conclusion, our study highlights OSA as a significant risk factor for early SSIs in elderly PLIF patients. The findings underscore the importance of preoperative screening for OSA. Given the increasing prevalence of OSA and its association with adverse surgical outcomes, early identification and management of OSA may play a key role in improving the safety and success of PLIF procedures in the aging population.

Data availability

No datasets were generated or analysed during the current study.

References

  1. Abbasi A, Gupta SS, Sabharwal N, Meghrajani V, Sharma S, Kamholz S, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci (Sao Paulo Brazil). 2021;14(2):142–54.

    Google Scholar 

  2. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70–81.

    Article  PubMed  Google Scholar 

  3. Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, et al. Obstructive sleep apnea and cardiovascular disease: A scientific statement from the American heart association. Circulation. 2021;144(3):e56–67.

    Article  CAS  PubMed  Google Scholar 

  4. Kariuki JK, Yang K, Scott PW, Chasens ER, Godzik C, Luyster FS, et al. Obstructive sleep apnea risk is associated with severity of metabolic syndrome: A secondary analysis of the 2015–2018 National health and nutrition examination survey. J Cardiovasc Nurs. 2022;37(5):482–9.

    Article  PubMed  Google Scholar 

  5. Chaudhry RA, Zarmer L, West K, Chung F. Obstructive sleep apnea and risk of postoperative complications after Non-Cardiac surgery. J Clin Med. 2024;13(9).

  6. Altree TJ, Chung F, Chan MTV, Eckert DJ. Vulnerability to postoperative complications in obstructive sleep apnea: importance of phenotypes. Anesth Analg. 2021;132(5):1328–37.

    Article  CAS  PubMed  Google Scholar 

  7. Almadani YH, Vorstenbosch J, Davison PG, Murphy AM. Wound healing: A comprehensive review. Semin Plast Surg. 2021;35(3):141–4.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Geers NC, Zegel M, Huybregts JGJ, Niessen FB. The influence of preoperative interventions on postoperative surgical wound healing in patients without risk factors: A systematic review. Aesthetic Surg J. 2018;38(11):1237–49.

    Article  Google Scholar 

  9. Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest. 2015;147(1):266–74.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Okuda S, Oda T, Miyauchi A, Haku T, Yamamoto T, Iwasaki M. Surgical outcomes of posterior lumbar interbody fusion in elderly patients. J Bone Joint Surg Am Volume. 2006;88(12):2714–20.

    Article  Google Scholar 

  11. Choi JM, Choi MK, Kim SB. Perioperative results and complications after posterior lumbar interbody fusion for spinal stenosis in geriatric patients over than 70 years old. J Korean Neurosurg Soc. 2017;60(6):684–90.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hayashi K, Matsumura A, Konishi S, Kato M, Namikawa T, Nakamura H. Clinical outcomes of posterior lumbar interbody fusion for patients 80 years of age and older with lumbar degenerative disease: minimum 2 years’ Follow-Up. Global Spine J. 2016;6(7):665–72.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ding N, Ni BQ, Wang H, Zhang SJ, Zhang XL. Obstructive sleep apnea: A risk factor of cardiac valve replacement surgery. J Clin Sleep Med. 2016;12(11):1573–5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fortis S, Colling KP, Statz CL, Glover JJ, Radosevich DM, Beilman GJ. Obstructive sleep apnea: A risk factor for surgical site infection following colectomy. Surg Infect (Larchmt). 2015;16(5):611–7.

    Article  PubMed  Google Scholar 

  15. Falowski SM, Provenzano DA, Xia Y, Doth AH. Spinal cord stimulation infection rate and risk factors: results from a united States payer database. Neuromodulation. 2019;22(2):179–89.

    Article  PubMed  Google Scholar 

  16. Bartolo K, Hill EA. The association between obstructive sleep Apnoea and wound healing: a systematic review. Sleep Breath. 2023;27(3):775–87.

    Article  PubMed  Google Scholar 

  17. Lutsey PL, Zineldin I, Misialek JR, Full KM, Lakshminarayan K, Ishigami J, et al. OSA and subsequent risk of hospitalization with pneumonia, respiratory infection, and total infection: the atherosclerosis risk in communities study. Chest. 2023;163(4):942–52.

    Article  PubMed  Google Scholar 

  18. Lal C, Weaver TE, Bae CJ, Strohl KP. Excessive daytime sleepiness in obstructive sleep apnea. Mechanisms and clinical management. Annals Am Thorac Soc. 2021;18(5):757–68.

    Article  Google Scholar 

  19. Lodge KM, Vassallo A, Liu B, Long M, Tong Z, Newby PR, et al. Hypoxia increases the potential for Neutrophil-mediated endothelial damage in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2022;205(8):903–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Janaszak-Jasiecka A, Siekierzycka A, Płoska A, Dobrucki IT, Kalinowski L. Endothelial Dysfunction Driven by Hypoxia-The Influence of Oxygen Deficiency on NO Bioavailability. Biomolecules. 2021;11(7).

  21. Egners A, Erdem M, Cramer T. The response of macrophages and neutrophils to hypoxia in the context of cancer and other inflammatory diseases. Mediat Inflamm. 2016;2016:2053646.

    Article  Google Scholar 

  22. Zhang M-H, Han X-X, Lu Y, Deng J-J, Zhang W-H, Mao J-Q, et al. Chronic intermittent hypoxia impaired collagen synthesis in mouse genioglossus via ROS accumulation: A transcriptomic analysis. Respir Physiol Neurobiol. 2023;308:103980.

    Article  CAS  PubMed  Google Scholar 

  23. Mitra AK, Bhuiyan AR, Jones EA. Association and risk factors for obstructive sleep apnea and cardiovascular diseases: A systematic review. Dis (Basel Switzerland). 2021;9(4).

  24. Cotterell A, Griffin M, Downer MA, Parker JB, Wan D, Longaker MT. Understanding wound healing in obesity. World J Experimental Med. 2024;14(1):86898.

    Article  Google Scholar 

  25. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and risk of surgical site infection: A systematic review and Meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):88–99.

    Article  PubMed  Google Scholar 

  26. Johnson KG, APAP. BPAP, CPAP, and new modes of positive airway pressure therapy. Adv Exp Med Biol. 2022;1384:297–330.

    Article  PubMed  Google Scholar 

  27. Kaw R, Dupuy-McCauley K, Wong J. Screening and perioperative management of obesity hypoventilation syndrome. J Clin Med. 2024;13(17).

  28. Chang JL, Goldberg AN, Alt JA, Mohammed A, Ashbrook L, Auckley D, et al. International consensus statement on obstructive sleep apnea. Int Forum Allergy Rhinol. 2023;13(7):1061–482.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. J Comp Eff Res. 2022;11(2):121–9.

    Article  CAS  PubMed  Google Scholar 

  30. Chen J, Li D, Wang R, Wang S, Shang Z, Wang M, et al. Benefits of the enhanced recovery after surgery program in Short-Segment posterior lumbar interbody fusion surgery. World Neurosurg. 2022;159:e303–10.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urological Surgery, People’s Hospital of Yuechi County, Guang’an, 638300, Sichuan, People’s Republic of China

    Jiao Lu

  2. Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People’s Republic of China

    Haiyang Xie, Jianwen Chen, Jiangtao He & Qian Chen

  3. Department of Orthopaedic and Reconstructive Surgery/Pediatric Orthopaedics, South China Hospital, Medical School, Shenzhen University, Shenzhen, 518116, People’s Republic of China

    Bingjiang Ma & Shuliang Li

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Contributions

J.L. designed the study and drafted the main manuscript text. H.X. and J.C. collected and analyzed the data. B.M. interpreted the results. J.H. contributed to data collection and analysis. Q.C. and S.L. supervised the study, critically reviewed the manuscript, and provided revisions. All authors reviewed and approved the final manuscript.

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Correspondence to Qian Chen or Shuliang Li.

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This study was approved by the research ethics committee of North Sichuan Medical College. Informed consent was obtained from all participants in the study.

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Lu, J., Xie, H., Chen, J. et al. The impact of obstructive sleep apnea on early surgical site infections in elderly PLIF patients: a retrospective propensity score-matched analysis. J Orthop Surg Res 20, 351 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13018-025-05777-1

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Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X