Abstract

To develop and internally validate a practical nomogram to predict the risk of surgical site infection (SSI) after cervical spondylosis surgery, using routinely available perioperative parameters. This single-center retrospective cohort study included 204 adult patients who underwent cervical stabilization for degenerative spondylosis at Ankara Bilkent City Hospital between April 2019 and April 2025. Demographic, clinical, and perioperative variables were collected, including age, sex, smoking, operative time, and length of hospital stay (LOS). The diagnosis of SSI was based on clinical documentation and was not determined independently. The primary outcome was SSI, defined as any postoperative wound infection documented during hospitalization or early follow-up. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of SSI. Model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve (AUC), and calibration was evaluated using Hosmer–Lemeshow statistics and a decile-based calibration plot. Among the 204 patients (mean age 51.4 ± 11.2 years; 42.2% male), SSI occurred in 7 patients (3.4%). In multivariable analysis, LOS was independently associated with SSI (adjusted odds ratio (OR) 1.37;95% confidence interval (CI) 1.02–1.83; p=0.039), while age, sex, and operative time were not significant predictors. The model achieved an AUC of 0.65, with good calibration (Hosmer–Lemeshow p=0.84) and internal validity confirmed by bootstrap resampling. Postoperative length of hospital stay (LOS) was identified as an independent and significant risk factor for surgical site infection (SSI) following cervical spondylosis surgery. The developed nomogram demonstrated moderate discriminative ability (AUC=0.65) and, using the Youden index, an optimal probability threshold of 0.053 was determined, corresponding to a sensitivity of 0.43 and specificity of 0.90. This tool provides a simple, reliable, and clinically applicable means to identify high-risk patients and guide infection prevention strategies.

Key words: Cervical Spondylosis Surgery, Surgical Site Infection, Nomograms, Length of Hospital Stay