P0824 INTESTINAL FATTY ACID BINDING PROTEIN AND RISK OF ACUTE PANCREATITIS AFTER POSTERIOR SPINAL FUSION SURGERY

Abstract

Introduction: Intestinal fatty acid binding protein (I-FABP) is a specific marker of enterocyte damage, and is a useful marker of intestinal ischemia/reperfusion. We previously reported that posterior spinal fusion in children is associated with early elevation of pro-inflammatory cytokines, and late postoperative complications such as acute pancreatitis (15–30%), sepsis (2–5%) and wound infection (5–8%). In this study we measured I-FABP levels at the end of surgery to see if this is a more specific marker for intestinal injury from ischemia/reperfusion and subsequent development of acute pancreatitis. Methods: After obtaining informed consent, children undergoing posterior spinal fusion were enrolled in an ongoing prospective study to identify markers predicting risk of post-operative complications. 7 who developed clinical acute pancreatitis and 9 matched controls were studied. Serum I-FABP was determined by using ELISA. Blood samples were taken at surgery start, and closure, and on post surgery day 1. Results: In most patients (13/16), I-FABP levels were elevated. I-FABP levels were significantly higher immediately post operative in those who subsequently developed pancreatitis vs. controls (343+/−320 pg/ml vs. 98.6+/−100.4 pg/ml, p<0.05). Indeed, 5/7 from pancreatitis, vs. 1/9 from Controls had levels >200 pg/ml ( OR=20, P<0.05). However, I-FABP levels were not associated with blood loss or systemic hypotension <55 mg Hg. Conclusion: Elevated I-FABP suggest that intestinal injury is common after posterior spinal fusion. Elevated I-FABP may be more specific than proinflammatory cytokines in predicting development of acute pancreatitis days later, and may prove to be a useful marker for intraoperative bowel ischemic injury.