Usefulness of inflammatory markers and clinical manifestation for an earlier method to diagnosis surgical site infection after spinal surgery.

Abstract

To put forward a method for earlier diagnosis of surgical site infection (SSI) after spinal surgery and identify the best cut-offs of the selective signs. Ninety cases were prospectively collected in consecutive patients who underwent spinal surgery. The patients were divided into the SSI group and the normal group. White blood cell (WBC) count, lymphocyte count, serum amyloid A (SAA), procalcitonin (PCT) and C-reactive protein (CRP) were collected pre-operatively and at three andsix days post-operatively. Erythrocyte sedimentation rates (ESR) were acquired pre-operatively and at six days post-operatively. Body temperature (BT) was measured every day during hospitalisation. The conditions of the surgical sites were recorded at three and sixdays post-operatively. Differences of BT, the conditions of the wound and the values of the inflammatory markers between the two groups were studied. Finally, we used the receiver operating characteristic curve (ROC curve) to determine the best cut-offs of the selected signs. Of the 90 patients, SSI occurred in seven and five of them reached a definite diagnosis of SSI as their bacterial cultures were positive. Significant differences were found in CRP levels at three and sixdays post-operatively with a cut-off of > 59.4mg/L and > 34.9mg/L, respectively; ESR level at sixdays post-operatively with a cut-off of > 51.5mm/h; PCT at three days post-operatively with a cut-off of > 0.11ng/mL; and BT at threedays post-operatively with a cut-off of > 37°C. Also, examination of the wound is also an important sign of SSI. CRP, ESR and PCT are considered useful markers for earlier diagnosis of SSI. Combining the above markers with BT and the wound condition yields more accurate results.