Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur Spine J. 2021 May;30(5):1261-1269. doi: 10.1007/s00586-021-06782-8. Epub 2021 Mar 7.
In spinal surgery, surgical site infections (SSI) after dorsal spondylodesis lead to severe short- and long-term complications. Despite various clinical and serological evidence, the detection of a postoperative SSI remains crucial. In this retrospective cohort study, we determined the prognostic value of C-reactive protein (CRP) kinetics after open reduction and dorsal spondylodesis in the development of a SSI.
We retrospectively analyzed 192 patients from 2016 to 2018 undergoing open reduction and dorsal spondylodesis with and without SSI for 20 days at a level-I trauma center and assessed their serological and clinical characteristics.
On day 7 and 8 after surgery, patients who developed a SSI displayed significantly higher CRP levels. A second peak after the initial maximum of CRP and a restricted failure to decline as well as a maximum CRP of more than 225 mg/l predict an infectious complication with a sensitivity of 92.9%, and a specificity of 78.2%. A binary logistic regression leads to 85.7% and 69.7%, respectively. A one-phase decay exponential regression can predict 75.6% of the variance after the initial peak of CRP.
Our study demonstrates a high value of postoperative CRP kinetics in SSI detection after dorsal spondylodesis. Moreover, we observed typical CRP levels with a specific course as indicative predictors that may facilitate an early SSI detection in clinical practice.
在脊柱外科手术中，后路脊柱融合术后的手术部位感染（SSI）会导致严重的短期和长期并发症。尽管有各种临床和血清学证据，但术后 SSI 的检测仍然至关重要。在这项回顾性队列研究中，我们确定了后路脊柱融合术后 C 反应蛋白（CRP）动力学对 SSI 发展的预后价值。
我们回顾性分析了 2016 年至 2018 年在一级创伤中心接受后路切开复位和脊柱融合术且术后 20 天内无 SSI 和有 SSI 的 192 例患者的血清学和临床特征。
在术后第 7 天和第 8 天，发生 SSI 的患者 CRP 水平显著升高。CRP 首次达到峰值后出现第二次高峰，且下降受限，以及 CRP 最大值超过 225mg/l，提示感染并发症的敏感性为 92.9%，特异性为 78.2%。二项逻辑回归分别导致 85.7%和 69.7%。一次相衰变指数回归可预测 CRP 初始峰值后 75.6%的变异。
我们的研究表明，后路脊柱融合术后 SSI 检测中术后 CRP 动力学具有很高的价值。此外，我们观察到具有特定病程的典型 CRP 水平作为指示性预测因子，可能有助于在临床实践中早期发现 SSI。
