Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
J Bone Joint Surg Am. 2020 Aug 19;102(16):1434-1444. doi: 10.2106/JBJS.19.01490.
Surgical site infection after spinal instrumentation increases morbidity and mortality as well as medical costs and is a burden to both patients and surgeons. Late-onset or sustained fever increases the suspicion for comorbid conditions. This retrospective, exploratory cohort study was conducted to identify the rate of and risk factors for sustained or late-onset postoperative fever after spinal instrumentation operations and to determine its relationship with surgical site infection.
Five hundred and ninety-eight patients who underwent lumbar or thoracic spinal instrumentation were retrospectively reviewed. The patients were divided according to (1) whether or not they had had a sustained fever (SF[+] or SF[-]) and (2) whether or not they had had a surgical site infection (SSI[+] or SSI[-]). Clinical characteristics, surgical factors, prophylactic antibiotic usage, fever pattern, and laboratory/imaging findings were recorded for all patients by electronic medical chart review.
In total, 68 patients (11.4%) had a sustained fever. The rate of surgical site infection was significantly higher when the patient had sustained fever (13.2% [9 of 68] compared with 0.9% [5 of 530]; p < 0.001). Comparison of the patients who had a sustained fever but no surgical site infection (SF[+], SSI[-]) and those with both a sustained fever and surgical site infection (SF[+], SSI[+]) showed that continuous fever, an increasing or stationary pattern of inflammatory markers, and a C-reactive protein (CRP) level of >4 mg/dL on postoperative days 7 to 10 were diagnostic clues for surgical site infection. The sensitivity and specificity of postoperative magnetic resonance imaging (MRI) for the detection of surgical site infection were 40.0% and 90.9%, respectively, when MRI was performed within 1 month after surgery.
Although most patients with sustained fever did not have surgical site infection, fever was significantly related to surgical site infection. Continuous fever, increasing patterns of inflammatory markers, and high CRP on postoperative days 7 to 10 were diagnostic clues for surgical site infection. This study demonstrated provisional results for factors that can discriminate febrile patients with surgical site infection from febrile patients without infection. Further investigation with a larger sample size is warranted for clarification.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
脊柱器械固定术后发生手术部位感染会增加发病率和死亡率，增加医疗费用，给患者和外科医生带来负担。迟发性或持续性发热会增加合并症的怀疑。本回顾性探索性队列研究旨在确定脊柱器械手术后持续性或迟发性术后发热的发生率和危险因素，并确定其与手术部位感染的关系。
回顾性分析 598 例接受腰椎或胸椎脊柱器械固定术的患者。根据（1）是否有持续性发热（SF[+]或 SF[-]）和（2）是否有手术部位感染（SSI[+]或 SSI[-]）将患者分为两组。通过电子病历回顾记录所有患者的临床特征、手术因素、预防性抗生素使用、发热模式和实验室/影像学检查结果。
共有 68 例患者（11.4%）出现持续性发热。持续性发热患者的手术部位感染率明显较高（13.2%[9/68]比 0.9%[5/530]；p<0.001）。比较有持续性发热但无手术部位感染（SF[+]，SSI[-]）和有持续性发热和手术部位感染（SF[+]，SSI[+]）的患者发现，术后第 7-10 天持续发热、炎症标志物呈增加或稳定模式以及 C 反应蛋白（CRP）水平>4mg/dL 是手术部位感染的诊断线索。术后 1 个月内进行 MRI 检查时，MRI 对手术部位感染的检测敏感性和特异性分别为 40.0%和 90.9%。
尽管大多数持续性发热患者没有手术部位感染，但发热与手术部位感染显著相关。术后第 7-10 天持续发热、炎症标志物增加模式和 CRP 升高是手术部位感染的诊断线索。本研究初步探讨了可区分有手术部位感染发热患者和无感染发热患者的因素。需要进一步研究以更大的样本量进行澄清。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
