Yamamoto Yusuke, Iwata Eiichiro, Shigematsu Hideki, Nakajima Hiroshi, Tanaka Masato, Okuda Akinori, Morimoto Yasuhiko, Masuda Keisuke, Koizumi Munehisa, Tanaka Yasuhito
Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
Department of Orthopedic Surgery, Otemae Hospital, Osaka, Japan.
Spine Surg Relat Res. 2018 Feb 28;2(2):127-134. doi: 10.22603/ssrr.2017-0052. eCollection 2018.
To identify the temporal comparison of biochemical markers for early detection of surgical site infection (SSI) following instrumented spinal fusion that are not affected by operative factors.
We reviewed data on C-reactive protein level and total white blood cell count and differential count before instrumented spinal fusion and at 1, 4, and 7 days postoperatively. The 141 patients in our sample were divided into an SSI group (patients who developed deep SSI) and a non-SSI group. We investigated the peak or nadir value day and identified those not affected by operative circumstances (operating time, intraoperative blood loss, and number of fusion segments) in the non-SSI group. If there was a significant difference between the peak or nadir value day and the next survey day, we considered the temporal comparison between these unaffected markers as an indicator of SSI and examined the usefulness of these indicators by calculating sensitivity and specificity. Furthermore, we investigated the usefulness of the combination of these markers (if even each one marker was recognized, we considered it positive).
Four biochemical markers of SSI were selected: neutrophil percentage at postoperative day 4 more than day 1 (sensitivity 36%, specificity 95%), neutrophil count at postoperative day 4 more than day 1 (sensitivity 46%, specificity 93%), lymphocyte percentage at postoperative day 4 less than day 1 (sensitivity 36%, specificity 90%), and lymphocyte count at postoperative day 4 less than day 1 (sensitivity 36%, specificity 90%). The combination of these markers showed sensitivity 100%, specificity 80%, respectively.
Four markers are reliable indicators for early detection of SSI following spinal instrumented fusion because they are not affected by operative factor. The combination of each indicator had both high sensitivity and specificity. Therefore, it is reliable and much useful for early detection of SSI.
确定用于早期检测器械辅助脊柱融合术后手术部位感染（SSI）的生化标志物的时间比较，且这些标志物不受手术因素影响。
我们回顾了器械辅助脊柱融合术前以及术后1天、4天和7天的C反应蛋白水平、白细胞总数及分类计数的数据。我们样本中的141例患者被分为SSI组（发生深部SSI的患者）和非SSI组。我们调查了峰值或谷值出现的日期，并确定非SSI组中不受手术情况（手术时间、术中失血和融合节段数）影响的标志物。如果峰值或谷值出现日期与下一次调查日期之间存在显著差异，我们将这些不受影响的标志物之间的时间比较视为SSI的一个指标，并通过计算敏感性和特异性来检验这些指标的有效性。此外，我们还研究了这些标志物组合的有效性（如果任何一个标志物被识别，我们就认为其为阳性）。
选择了四个SSI的生化标志物：术后第4天中性粒细胞百分比高于第1天（敏感性36%，特异性95%），术后第4天中性粒细胞计数高于第1天（敏感性46%，特异性93%），术后第4天淋巴细胞百分比低于第1天（敏感性36%，特异性90%），以及术后第4天淋巴细胞计数低于第1天（敏感性36%，特异性90%）。这些标志物的组合分别显示敏感性为100%，特异性为80%。
四个标志物是器械辅助脊柱融合术后早期检测SSI的可靠指标，因为它们不受手术因素影响。每个指标的组合具有高敏感性和特异性。因此，它对于SSI的早期检测是可靠且非常有用的。
