Lymphopenia at 4 Days Postoperatively Is the Most Significant Laboratory Marker for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

• Main Authors: Eiichiro Iwata, Hideki Shigematsu, Akinori Okuda, Yasuhiko Morimoto, Keisuke Masuda, Hiroshi Nakajima, Munehisa Koizumi, Yasuhito Tanaka
• Format: Article
• Language: English
• Published: Korean Spine Society 2016-12-01
• Series: Asian Spine Journal
• Subjects: Surgical wound infection; Instrumentation; Biomarkers; Lymphopenia; Leukocytes
• Online Access: http://www.asianspinejournal.org/upload/pdf/asj-10-1042.pdf

Study DesignCase control study.PurposeTo identify the most significant laboratory marker for early detection of surgical site infection (SSI) using multiple logistic regression analysis.Overview of LiteratureSSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial.MethodsWe retrospectively reviewed the laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spinal disease from January 2003 to December 2014. Six laboratory markers for early SSI detection were considered: renewed elevation of the white blood cell count, higher at 7 than 4 days postoperatively; renewed elevation of the C-reactive protein (CRP) level, higher at 7 than 4 days postoperatively; CRP level of >10 mg/dL at 4 days postoperatively; neutrophil percentage of >75% at 4 days postoperatively; lymphocyte percentage of <10% at 4 days postoperatively; and lymphocyte count of <1,000/µL at 4 days postoperatively.ResultsNinety patients were enrolled; five developed deep SSI. Multivariate regression analysis showed that a lymphocyte count of <1,000/µL at 4 days postoperatively was the sole significant independent laboratory marker for early detection of SSI (p=0.037; odds ratio, 11.9; 95% confidence interval, 1.2–122.7).ConclusionsA lymphocyte count of <1,000/µL at 4 days postoperatively is the most significant laboratory marker for early detection of SSI.