Early diagnosis of deep infection after spine surgeries

English Keywords:Spine surgery  Surgical site infection  Infection-related indicator

English Abstract:

  【Abstract】 Objectives: To investigate the early changes of various infection-related indicators after spine surgeries, and to provide more reliable evidence for the early diagnosis of deep infection. Methods: 24 patients(20 males and 4 females, with age ranging from 14 to 75 years old) diagnosed as deep surgical site infection in Spine Surgery Center of Huashan Hospital, Fudan University between January 2001 and December 2012 were reviewed retrospectively. Meanwhile, 51 patients undergoing spine surgeries in the same period without postoperative surgical site infection were enrolled in control group(29 males and 22 females, with age ranging from 19 to 81 years old). The leukocyte counts, neutrophil counts, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) in the peripheral blood, as well as body temperature and local wound conditions of all patients were recorded on the 3rd and 5/6th day postoperatively. The leukocyte counts, neutrophil counts, ESR, CRP and body temperature were considered abnormal when they exceeded x+2s than those of the control group. Local wound conditions were considered abnormal when presented with redness, swelling, heat and pain with or without exudation. Results: Compared with the control group, patients with deep surgical site infection showed higher CRP value(P=0.005) on 3 days postoperatively, and higher CRP value(P=0.000), neutrophil counts(P=0.020) and body temperature(P=0.001) on 5/6 days postoperatively. In 24 patients with postoperative deep surgical site infection, 8 patients(33.3%) showed abnormal fervescence. 2 patients(8.3%) showed abnormal increase of leukocyte counts. 11 patients(45.8%) showed abnormal increase of neutrophil counts. 18 patients(75%) showed significantly higher ESR than the control group, while 21 patients(87.5%) showed significantly higher CRP value. Only 3 patients(12.5%) presented with redness, swelling, heat and pain with or without exudation in 1 week postoperatively. Therefore, the sensitivity of CRP and ESR in diagnosing deep surgical site infection was significantly higher than that of other indicators, such as body temperature, local wound conditions, leukocyte counts and neutrophil counts(P<0.05). Although there was no abnormal fever or local wound problem, no significant difference of various infection indicators in the peripheral blood was noted between the patients with acute or delayed deep infection(P>0.05). Conclusions: Early routine quantitative evaluation of the abnormal changes of various infection indicators in the peripheral blood, especially CRP value is an effective way to diagnose deep surgical site infection, particularly in the patients with delayed deep surgical site infection and without obvious fever and/or local wound infection presentation.