Kudo Daisuke, Miyakoshi Naohisa, Hongo Michio, Kasukawa Yuji, Ishikawa Yoshinori, Mizutani Takashi, Shimada Yoichi
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Eur Spine J. 2017 Dec;26(12):3156-3161. doi: 10.1007/s00586-016-4855-z. Epub 2016 Nov 10.
Malnutrition is one of the important risk factors for postoperative complications. Transferrin, prealbumin, and retinol-binding protein, so-called rapid turnover proteins (RTPs), may be the better indicators for early detection of nutritional deficits. However, few studies have described the impact of serum RTP levels on postoperative surgical site infection (SSI) in spine surgery. The purpose of this study was to investigate the relationship between preoperative serum RTPs and postoperative SSI.
The data of 105 patients (64 male, 41 female; average age 64.4 years; age range 20-88 years) who underwent spine surgery in a single institution between 2014 and 2015 were retrospectively analyzed. Preoperative total lymphocyte count, serum albumin, transferrin, prealbumin, retinol-binding protein, pre-and postopeartive C-reactive protein (CRP), white blood cell count (WBC), and total lymphocyte count were evaluated. Postoperative CRP, WBC, and total lymphocyte count were repeated two or three times/week until hospital discharge. A broad spectrum penicillin or second generation cephalosporin was administered as a prophylactic antibiotic to each patient. When repeated CRP elevation or lymphopenia (no more than 10% or 1000/μL) after postoperative day 3 or 4 was observed, possible SSI was diagnosed. Variables between possible SSI group and non-SSI group were compared using Mann-Whitney U or Chi square test. All variables on univariate analysis were included in multiple logistic regression analysis to identify risk factors for possible postoperative SSI.
Thirty-five patients were diagnosed with possible SSI. The mean operative time of possible SSI group was significantly longer (p = 0.036), preoperative total lymphocyte count and serum prealbumin level of possible SSI group were significantly lower (p = 0.002, p = 0.048, respectively) than that of non-SSI group. On univariate analysis, operative time (p = 0.012), preoperative total lymphocyte count (p = 0.041), serum albumin level (p = 0.038), and serum prealbumin level (p = 0.044) were significant contributors to possible SSI, and multiple logistic regression analysis revealed that operative time was the significant contributor to possible SSI (odds ratio 1.008, 95% confidence interval (CI) 1.001-1.015, p = 0.024).
A low prealbumin level is a possible risk factor for early-stage SSI in spine surgery, though it was not statistically significant; operative time was the most important indicator of SSI on multivariate analysis.
营养不良是术后并发症的重要危险因素之一。转铁蛋白、前白蛋白和视黄醇结合蛋白，即所谓的快速周转蛋白（RTPs），可能是早期发现营养缺乏的更好指标。然而，很少有研究描述血清RTP水平对脊柱手术术后手术部位感染（SSI）的影响。本研究的目的是探讨术前血清RTPs与术后SSI之间的关系。
回顾性分析2014年至2015年在单一机构接受脊柱手术的105例患者（男64例，女41例；平均年龄64.4岁；年龄范围20 - 88岁）的数据。评估术前总淋巴细胞计数、血清白蛋白、转铁蛋白、前白蛋白、视黄醇结合蛋白、术前和术后C反应蛋白（CRP）、白细胞计数（WBC）和总淋巴细胞计数。术后CRP、WBC和总淋巴细胞计数每周重复检测两到三次，直至出院。每位患者均给予广谱青霉素或第二代头孢菌素作为预防性抗生素。当术后第3天或第4天观察到CRP反复升高或淋巴细胞减少（不超过10%或1000/μL）时，诊断为可能的SSI。使用Mann-Whitney U检验或卡方检验比较可能的SSI组和非SSI组之间的变量。单因素分析中的所有变量均纳入多因素逻辑回归分析，以确定术后可能发生SSI的危险因素。
35例患者被诊断为可能的SSI。可能的SSI组的平均手术时间明显更长（p = 0.036），可能的SSI组术前总淋巴细胞计数和血清前白蛋白水平明显低于非SSI组（分别为p = 0.002，p = 0.048）。单因素分析显示，手术时间（p = 0.012）、术前总淋巴细胞计数（p = 0.041）、血清白蛋白水平（p = 0.038）和血清前白蛋白水平（p = 0.044）是可能发生SSI的重要因素，多因素逻辑回归分析显示手术时间是可能发生SSI的重要因素（比值比1.008，95%置信区间（CI）1.001 - 1.015，p = 0.024）。
尽管术前前白蛋白水平不是脊柱手术早期SSI的统计学显著危险因素，但它是一个可能的危险因素；多因素分析中手术时间是SSI最重要的指标。
