C-reactive Protein in Spinal Surgery: More Predictive Than Prehistoric

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2021 Mar 8

PMID 33682035

Citations 14

Authors

S Hoeller

P J Roch

L Weiser

J Hubert

W Lehmann

D Saul

Affiliations

Soon will be listed here.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Citing Articles

Predicting Surgical Site Infections in Spine Surgery: Association of Postoperative Lymphocyte Reduction.

Miyamoto A, Tanaka M, Flores A, Yu D, Jain M, Heng C Diagnostics (Basel). 2024; 14(23).

PMID: 39682623 PMC: 11640511. DOI: 10.3390/diagnostics14232715.

Cerebrospinal Fluid Leakage Combined with Blood Biomarkers Predicts Poor Wound Healing After Posterior Lumbar Spinal Fusion: A Machine Learning Analysis.

Pang Z, Ou Y, Liang J, Huang S, Chen J, Huang S Int J Gen Med. 2024; 17:5479-5491.

PMID: 39619131 PMC: 11606187. DOI: 10.2147/IJGM.S487967.

Prediction models for risk assessment of surgical site infection after spinal surgery: A systematic review.

Lauinger A, Blake S, Fullenkamp A, Polites G, Grauer J, Arnold P N Am Spine Soc J. 2024; 19:100518.

PMID: 39253699 PMC: 11382011. DOI: 10.1016/j.xnsj.2024.100518.

Is an Elevated Preoperative CRP Level a Predictive Factor for Wound Healing Disorders following Lumbar Spine Surgery?.

Pinchuk A, Luchtmann M, Neyazi B, Dumitru C, Stein K, Sandalcioglu I J Pers Med. 2024; 14(7).

PMID: 39063921 PMC: 11278350. DOI: 10.3390/jpm14070667.

[Prospective comparative study of unilateral biportal endoscopic transforaminal lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for treatment of single-segment degenerative lumbar spinal stenosis with lumbar...].

Wu D, Shu T, Lu Q, Shen M Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024; 38(5):521-528.

PMID: 38752236 PMC: 11096877. DOI: 10.7507/1002-1892.202402058.

References

Deng H, Yue J, Ordaz A, Suen C, Sing D . Elective lumbar fusion in the United States: national trends in inpatient complications and cost from 2002-2014. J Neurosurg Sci. 2019; 65(5):503-512. DOI: 10.23736/S0390-5616.19.04647-2. View

Walker C, Kakarla U, Chang S, Sonntag V . History and advances in spinal neurosurgery. J Neurosurg Spine. 2019; 31(6):775-785. DOI: 10.3171/2019.9.SPINE181362. View

Brown E, Pople I, de Louvois J, Hedges A, Bayston R, Eisenstein S . Spine update: prevention of postoperative infection in patients undergoing spinal surgery. Spine (Phila Pa 1976). 2004; 29(8):938-45. DOI: 10.1097/00007632-200404150-00023. View

Dowdell J, Brochin R, Kim J, Overley S, Oren J, Freedman B . Postoperative Spine Infection: Diagnosis and Management. Global Spine J. 2018; 8(4 Suppl):37S-43S. PMC: 6295816. DOI: 10.1177/2192568217745512. View

Fang A, Hu S, Endres N, Bradford D . Risk factors for infection after spinal surgery. Spine (Phila Pa 1976). 2005; 30(12):1460-5. DOI: 10.1097/01.brs.0000166532.58227.4f. View

Janssen D, van Kuijk S, dAumerie B, Willems P . A prediction model of surgical site infection after instrumented thoracolumbar spine surgery in adults. Eur Spine J. 2019; 28(4):775-782. DOI: 10.1007/s00586-018-05877-z. View

Schimmel J, Horsting P, De Kleuver M, Wonders G, van Limbeek J . Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010; 19(10):1711-9. PMC: 2989231. DOI: 10.1007/s00586-010-1421-y. View

Weinstein M, McCabe J, Cammisa Jr F . Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord. 2000; 13(5):422-6. DOI: 10.1097/00002517-200010000-00009. View

Lethbridge L, Richardson C, Dunbar M . Measuring Surgical Site Infection From Linked Administrative Data Following Hip and Knee Replacement. J Arthroplasty. 2019; 35(2):528-533. DOI: 10.1016/j.arth.2019.09.025. View

10.

Muilwijk J, Walenkamp G, Voss A, Wille J, van den Hof S . Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network 'PREZIES'. J Hosp Infect. 2006; 62(3):319-26. DOI: 10.1016/j.jhin.2005.08.006. View

11.

Kalfas F, Severi P, Scudieri C . Infection with Spinal Instrumentation: A 20-Year, Single-Institution Experience with Review of Pathogenesis, Diagnosis, Prevention, and Management. Asian J Neurosurg. 2020; 14(4):1181-1189. PMC: 6896624. DOI: 10.4103/ajns.AJNS_129_19. View

12.

Lazzeri E, Bozzao A, Cataldo M, Petrosillo N, Manfre L, Trampuz A . Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults. Eur J Nucl Med Mol Imaging. 2019; 46(12):2464-2487. DOI: 10.1007/s00259-019-04393-6. View

13.

Schuster J, Rechtine G, Norvell D, Dettori J . The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine (Phila Pa 1976). 2010; 35(9 Suppl):S125-37. DOI: 10.1097/BRS.0b013e3181d8342c. View

14.

Choi M, Kim S, Kim K, Ament J . Sequential Changes of Plasma C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Spine Surgery : Comparison between Lumbar Open Discectomy and Posterior Lumbar Interbody Fusion. J Korean Neurosurg Soc. 2014; 56(3):218-23. PMC: 4217058. DOI: 10.3340/jkns.2014.56.3.218. View

15.

Sperandei S . Understanding logistic regression analysis. Biochem Med (Zagreb). 2014; 24(1):12-8. PMC: 3936971. DOI: 10.11613/BM.2014.003. View

16.

Garcia D, Deckey D, Zega A, Mayfield C, Spake C, Emanuel T . Analysis of growth and biofilm formation of bacterial pathogens on frequently used spinal implant materials. Spine Deform. 2020; 8(3):351-359. DOI: 10.1007/s43390-020-00054-z. View

17.

Yin D, Liu B, Chang Y, Gu H, Zheng X . Management of late-onset deep surgical site infection after instrumented spinal surgery. BMC Surg. 2018; 18(1):121. PMC: 6303994. DOI: 10.1186/s12893-018-0458-4. View

18.

Bingham J, Hassebrock J, Christensen A, Beauchamp C, Clarke H, Spangehl M . Screening for Periprosthetic Joint Infections With ESR and CRP: The Ideal Cutoffs. J Arthroplasty. 2019; 35(5):1351-1354. DOI: 10.1016/j.arth.2019.11.040. View

19.

Neumaier M, Braun K, Sandmann G, Siebenlist S . C-Reactive Protein in Orthopaedic Surgery. Acta Chir Orthop Traumatol Cech. 2015; 82(5):327-31. View

20.

Chung Y, Won Y, Kwon Y, Shin H, Choi C, Yeom J . Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery. J Korean Neurosurg Soc. 2011; 49(1):43-8. PMC: 3070894. DOI: 10.3340/jkns.2011.49.1.43. View