Assessment of risk factors for surgical site infection following tibial plateau levelling osteotomy: a systematic review and meta-analysis

The aim of this systematic review was to critically assess the available evidence regarding risk factors associated with surgical site infections following tibial plateau levelling osteotomy. This study aims to identify clinically relevant determinants of surgical site infection following tibial plateau levelling osteotomy and inform future preventive strategies. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The review question was structured using the PECOS framework. Searches were performed in PubMed, Web of Science and Scopus without date restrictions, including all studies indexed up to June 2025. The search strategy combined terms related to surgical site infection, tibial plateau levelling osteotomy and dogs. Risk of bias was assessed across predefined methodological domains. The literature search yielded 436 results, and a total of 11 papers met the inclusion criteria. The study designs included two prospective clinical trials, one double-blinded randomised controlled trial and eight retrospective case series. Several risk factors for postoperative surgical site infection were investigated across the studies, with increased body weight being the most frequently identified. Most of the studies presented a high risk of bias in the domains of allocation concealment, blinding of participants and personnel and blinding of outcome assessment. In contrast, incomplete outcome data and selective reporting were generally assessed as low risk of bias. Knowledge of specific risk factors for surgical site infection after tibial plateau levelling osteotomy may support the clinician in tailoring antimicrobial prophylaxis and anticipating potential complications, thereby improving perioperative decision-making and patient outcomes.