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Objective <p>To investigate the effect of bisphosphonates on surgical site infection (SSI) and their safety in postmenopausal women undergoing Anterior Cervical Discectomy and Fusion (ACDF).</p> Methods <p>This was a single-center retrospective cohort study analyzing female patients who underwent ACDF from the hospital database between 2016 and 2024. All surgeries were performed by certified spine surgeons. The primary outcome was surgical site infection (SSI) within 30 days postoperatively (or within 90 days if implants were present). Patients were divided into a group receiving intravenous zoledronic acid (medication group, the median postoperative day for the first intravenous infusion of zoledronic acid (5 mg) being Day 2 (IQR: 1–3)) and a non-medication group based on postoperative bisphosphonate use. Propensity score matching was used to balance baseline characteristics. Binary logistic regression analysis was employed to identify factors associated with SSI.</p> Results <p>Among 987 eligible patients, 224 were in the bisphosphonate group and 763 were in the non-bisphosphonate group. The incidence of SSI was lower in the intravenous zoledronic acid group (2.2% vs. 7.5%). After propensity score matching (221 medication users vs. 412 non-users), all baseline variables were well balanced (absolute standardized mean differences all &lt; 0.1). Logistic regression analysis in the matched cohort showed that intravenous zoledronic acid use was an independent protective factor against SSI (adjusted odds ratio [aOR] = 0.136, 95% CI: 0.048–0.384, P &lt; 0.001), while smoking was a risk factor (aOR = 3.856, 95% CI: 1.153–12.900, P = 0.028). There was no significant difference in adverse events between the two groups.</p> Conclusion <p>In postmenopausal osteoporotic women undergoing ACDF, postoperative bisphosphonate use was significantly associated with a reduced risk of surgical site infection and did not increase short-term adverse events.</p>

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Effect of bisphosphonates on the risk of surgical site infection after anterior cervical discectomy and fusion (ACDF) in postmenopausal women with osteoporosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Weilin Zhang,
  • Boyuan Zhou,
  • Canchang Chen,
  • Dao Feng,
  • Junyi Zhang,
  • Zhencong Li,
  • Jinguo Liang,
  • Shengbang Huang,
  • Zhiwen Dai,
  • Cheng Luo,
  • Jinsong Wei

摘要

Objective

To investigate the effect of bisphosphonates on surgical site infection (SSI) and their safety in postmenopausal women undergoing Anterior Cervical Discectomy and Fusion (ACDF).

Methods

This was a single-center retrospective cohort study analyzing female patients who underwent ACDF from the hospital database between 2016 and 2024. All surgeries were performed by certified spine surgeons. The primary outcome was surgical site infection (SSI) within 30 days postoperatively (or within 90 days if implants were present). Patients were divided into a group receiving intravenous zoledronic acid (medication group, the median postoperative day for the first intravenous infusion of zoledronic acid (5 mg) being Day 2 (IQR: 1–3)) and a non-medication group based on postoperative bisphosphonate use. Propensity score matching was used to balance baseline characteristics. Binary logistic regression analysis was employed to identify factors associated with SSI.

Results

Among 987 eligible patients, 224 were in the bisphosphonate group and 763 were in the non-bisphosphonate group. The incidence of SSI was lower in the intravenous zoledronic acid group (2.2% vs. 7.5%). After propensity score matching (221 medication users vs. 412 non-users), all baseline variables were well balanced (absolute standardized mean differences all < 0.1). Logistic regression analysis in the matched cohort showed that intravenous zoledronic acid use was an independent protective factor against SSI (adjusted odds ratio [aOR] = 0.136, 95% CI: 0.048–0.384, P < 0.001), while smoking was a risk factor (aOR = 3.856, 95% CI: 1.153–12.900, P = 0.028). There was no significant difference in adverse events between the two groups.

Conclusion

In postmenopausal osteoporotic women undergoing ACDF, postoperative bisphosphonate use was significantly associated with a reduced risk of surgical site infection and did not increase short-term adverse events.