Miyamoto Akiyoshi, Tanaka Masato, Flores Angel Oscar Paz, Yu Dongwoo, Jain Mukul, Heng Christan, Komatsubara Tadashi, Arataki Shinya, Oda Yoshiaki, Shinohara Kensuke, Uotani Koji
Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan.
Department of Orthopedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan.
Diagnostics (Basel). 2024 Dec 2;14(23):2715. doi: 10.3390/diagnostics14232715.
Postoperative lymphopenia is reported as an excellent indicator to predict surgical-site infection (SSI) after spine surgery. However, there is still controversy concerning which serological markers can predict spinal SSI. This study aims to evaluate excellent and early indicators for detecting SSI, focusing on spine instrumented surgery.
This study included 268 patients who underwent spinal instrumented surgery from January 2022 to December 2023 (159 female and 109 male, average 62.9 years). The SSI group included 20 patients, and the non-SSI group comprised 248 patients. Surgical time, intraoperative blood loss, and glycemic levels were measured in both groups. The complete blood cell counts, differential counts, albumin, and C-reactive protein (CRP) levels were measured pre-surgery and postoperative on Days 1, 3, and 7. In comparing the groups, the Mann-Whitney U test analysis was used for continuous variables, while the chi-squared test and Fisher's exact test were used for dichotomous variables.
The incidence of SSI after spinal instrumentation was 7.46% and was relatively higher in scoliosis surgery. The SSI group had significantly longer surgical times (248 min vs. 180 min, = 0.0004) and a higher intraoperative blood loss (772 mL vs. 372 mL, < 0.0001) than the non-SSI group. In the SSI group, the Day 3 (10.5 ± 6.2% vs. 13.8 ± 6.0%, = 0.012) and Day 7 (14.4 ± 4.8% vs. 18.8 ± 7.1%, = 0.012) lymphocyte ratios were lower than the non-SSI group. Albumin levels on Day 1 in the SSI group were lower than in the non-SSI group (2.94 ± 0.30 mg/dL vs. 3.09 ± 0.38 mg/dL, = 0.045). There is no difference in CRP and lymphocyte count between the two groups.
SSI patients had lower lymphocyte percentages than non-SSI patients, which was a risk factor for SSI, with constant high inflammation. The Day 3 lymphocyte percentage may predict SSI after spinal instrumented surgery.
术后淋巴细胞减少被报道为预测脊柱手术后手术部位感染（SSI）的一个极佳指标。然而，关于哪些血清学标志物能够预测脊柱SSI仍存在争议。本研究旨在评估检测SSI的优良及早期指标，重点关注脊柱内固定手术。
本研究纳入了2022年1月至2023年12月期间接受脊柱内固定手术的268例患者（159例女性和109例男性，平均年龄62.9岁）。SSI组包括20例患者，非SSI组包括248例患者。两组均测量了手术时间、术中失血量和血糖水平。术前以及术后第1、3和7天测量全血细胞计数、分类计数、白蛋白和C反应蛋白（CRP）水平。在比较两组时，连续变量采用曼-惠特尼U检验分析，二分变量采用卡方检验和费舍尔精确检验。
脊柱内固定术后SSI的发生率为7.46%，在脊柱侧弯手术中相对较高。与非SSI组相比，SSI组的手术时间显著更长（248分钟对180分钟，P = 0.0004），术中失血量更高（772毫升对372毫升，P < 0.0001）。在SSI组中，第3天（10.5±6.2%对13.8±6.0%，P = 0.012）和第7天（14.4±4.8%对18.8±7.1%，P = 0.012）的淋巴细胞比率低于非SSI组。SSI组第1天的白蛋白水平低于非SSI组（2.94±0.30毫克/分升对3.09±0.38毫克/分升，P = 0.045）。两组之间的CRP和淋巴细胞计数无差异。
SSI患者的淋巴细胞百分比低于非SSI患者，这是SSI的一个危险因素，伴有持续的高度炎症反应。术后第3天的淋巴细胞百分比可能预测脊柱内固定手术后的SSI。
