Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Eur Spine J. 2021 Jun;30(6):1765-1773. doi: 10.1007/s00586-020-06622-1. Epub 2020 Oct 9.
Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, little is known about the relationship between SSI and the PNI in patients after spine surgery. We aimed to determine independent predictors of SSI after spine surgery.
We analyzed 1115 patients who underwent spine surgery (369 males, 746 females, mean age 56 years, follow-up period: at least 1 year). Patients were divided into SSI and non-SSI groups. Preoperative risk factors, including PNI (10 × serum albumin [g/dL] + 0.005 × total lymphocyte count [/μL]), were assessed.
Postoperatively, 43 patients (3.9%) experienced SSI. Univariate analysis showed that preoperative PNI (48.5 vs 51.7; p < 0.01), revision status (p < 0.05), male sex (p < 0.01), body mass index (BMI) (p < 0.05), and usage of anticoagulant agents (p < 0.05) differed significantly between the SSI and non-SSI groups. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.90-0.98; p < 0.01), male sex (OR, 2.64; 95% CI: 1.40-4.99; p < 0.01), length of surgery ≥ 180 min (OR, 2.78; 95% CI: 1.30-5.96; p < 0.01), BMI ≥ 30 kg/m (OR, 2.89; 95% CI: 1.20-6.97; p < 0.05), and revision status (OR, 2.30; 95% CI: 1.07-4.98; p < 0.05) were independently associated with SSI postoperatively.
Lower preoperative PNI was found to be a risk factor for SSI after spine surgery. Patients with lower preoperative PNI values should be cautioned about the risk of SSI and provide adequate informed consent.
营养不良被报道为手术部位感染（SSI）的风险因素之一。预后营养指数（PNI）是一种简单的营养评估方法。然而，关于脊柱手术后 SSI 与 PNI 之间的关系知之甚少。我们旨在确定脊柱手术后 SSI 的独立预测因素。
我们分析了 1115 例接受脊柱手术的患者（369 名男性，746 名女性，平均年龄 56 岁，随访期：至少 1 年）。患者分为 SSI 和非 SSI 组。评估了术前危险因素，包括 PNI（10×血清白蛋白[g/dL]+0.005×总淋巴细胞计数[/μL]）。
术后 43 例（3.9%）发生 SSI。单因素分析显示，术前 PNI（48.5 比 51.7；p<0.01）、翻修状态（p<0.05）、男性（p<0.01）、体质指数（BMI）（p<0.05）和抗凝剂使用（p<0.05）在 SSI 和非 SSI 组之间差异有统计学意义。多因素 logistic 回归分析显示，术前 PNI（比值比[OR]，0.94；95%置信区间[CI]：0.90-0.98；p<0.01）、男性（OR，2.64；95%CI：1.40-4.99；p<0.01）、手术时间≥180 分钟（OR，2.78；95%CI：1.30-5.96；p<0.01）、BMI≥30kg/m（OR，2.89；95%CI：1.20-6.97；p<0.05）和翻修状态（OR，2.30；95%CI：1.07-4.98；p<0.05）与术后 SSI 独立相关。
术前较低的 PNI 被发现是脊柱手术后 SSI 的危险因素。术前 PNI 值较低的患者应警惕 SSI 的风险，并提供充分的知情同意。
