Factors Associated with Delayed Inflammatory Recovery after Spinal Surgery without Surgical Site Infection: A Retrospective Study

Author(s): Hideaki Imabayashi, Atsushi Miyake, Kazuhiro Chiba

Background: We have previously reported ten effective serological indicators of surgical site infection (SSI) in the perioperative period after spinal surgery. However, the false-positive fractions of these markers were 0.15-0.39 which frequencies were not negligible. These mean the delays of surgical inflammatory recoveries without SSI. This study aimed to identify and classify the factors associated with these delays.

Methods: This retrospective study enrolled 320 patients who underwent spinal surgery for causes other than infectious spondylitis without surgical site infection. Demographic data, preoperative serological data, operative times, and operative methods were examined by multivariate regression for each SSI indicator and classified into related groups.

Results: Nine significantly associated factors, age, malignancy, preoperative total protein, albumin, white blood cell count, albumin/globulin ratio, C-reactive protein, operation time, and use of spinal instrumentation were found. We classified the patients into three groups according to their preoperative nutritional status, immune-inflammation status, and surgical procedure. Malnutrition, high CRP and WBC, older age, and malignancy might be related to delays in surgical recovery without SSI; therefore, a single indicator may have limited capability in detecting SSI.

Conclusions: We have to recognize the several causes to retard surgical inflammatory recovery. Improved preoperative conditions and less invasive surgery may decrease delays and improve the accuracy of SSI indicators.