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Multiple factors influence postoperative complications and recurrence, though their associations remain unclear. We performed a PRISMA\u2010guided systematic review and meta\u2010analysis to assess predictors of acute postoperative complications and PI recurrence in SCI patients undergoing surgery. PubMed, Scopus and Embase were searched. Studies with \u2265\u200915 participants were eligible; 24 (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092566 subjects) were included, with 15 (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091976 subjects) quantitatively synthesized. Risk of bias was assessed with the Newcastle\u2010Ottawa Scale. A random\u2010effects model meta\u2010analysis was performed, and odds ratios (OR) were pooled when &gt;\u20092 studies were available; otherwise, findings were narratively synthesized. Moderate\u2010quality evidence showed prior flap reconstruction increased complication risk (aOR\u2009=\u20094.98). Low\u2010quality evidence linked diabetes (OR\u2009=\u20091.39) and smoking (OR\u2009=\u20091.35) with complications. Higher recurrence risk was associated with prior flap reconstruction (OR\u2009=\u20091.80) and thoracic injury (OR\u2009=\u20092.21), while cervical injury was protective (OR\u2009=\u20090.37). Prior flap reconstruction resulted as the strongest predictor of complications and significantly increased the odds of recurrence. These findings underscore the importance of a multidisciplinary approach for preventing the first occurrence of flap reconstruction and subsequent procedures.\n                  <\/jats:p>","DOI":"10.1111\/iwj.70915","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T01:45:12Z","timestamp":1777254312000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Complications and Recurrence After Pressure Injury Reconstruction in Spinal Cord Injury: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"23","author":[{"given":"Marlynn P.","family":"Lopez","sequence":"first","affiliation":[{"name":"Carle Illinois College of Medicine  Urbana Illinois USA"},{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery Northwestern University Feinberg School of Medicine  Chicago Illinois 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