Usefulness of White Blood Cell Differential for Early Diagnosis of Surgical Wound Infection Following Spinal Instrumentation Surgery

Takahashi, J.; Shono, Yasuhiro; Hirabayashi, Hiroki; Kamimura, Mikio; Nakagawa, Hiroyuki; Ebara, Sohei; Kato, Hiroyuki

doi:10.1097/01.brs.0000214895.67956.60

Cited by 61 publications

(84 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…WBC count has been a less reliable indicator for infection. Takahashi et al [21] found that the most sensitive parameter for enhanced inflammation elicited by implants appears to be CRP because its level increased sharply immediately after surgery, reaching a high peak level on day two. The authors concluded that hardware was the cause of the acute inflammatory response with a high CRP level after surgery.…”

Section: Diagnosismentioning

confidence: 99%

Infections in spinal instrumentation

Gerometta

Olaverri

Bitan

2012

International Orthopaedics (SICOT)

127

View full text Add to dashboard Cite

Surgical-site infection (SSI ) in the spine is a serious postoperative complication. Factors such as posterior surgical approach, arthrodesis, use of spinal instrumentation, age, obesity, diabetes, tobacco use, operating-room environment and estimated blood loss are well established in the literature to affect the risk of infection. Infection after spine surgery with instrumentation is becoming a common pathology. The reported infection rates range from 0.7% to 11.9%, depending on the diagnosis and complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. These infections after instrumented spinal fusion are particularly difficult to manage due to the implanted, and possibly infected, instrumentation. Because the medical, economic and social costs of SSI after spinal instrumentation are enormous, any significant reduction in risks will pay dividends. The goal of this literature review was to analyse risk factors, causative organisms, diagnostic elements (both clinical and biological), different treatment options and their efficiency and consequences and the means of SSI prevention.

show abstract

Section: Diagnosismentioning

confidence: 99%

Infections in spinal instrumentation

Gerometta

Olaverri

Bitan

2012

International Orthopaedics (SICOT)

127

View full text Add to dashboard Cite

show abstract

“…Biomarkers, such as elevated serum C-reactive protein (CrP), white blood cell (WBC) counts, and erythrocyte sedimentation rate (ESr) can assist in diagnosing deep subfascial infection, but often are not diagnostic. In adults with instrumented spinal fusion, CrP peaks at second postoperative day, and it may remain elevated for almost 6 weeks making differential diagnosis of systemic inflammatory response and deep surgical wound infection difficult (7)(8)(9)(10). Similarly, ESr peaks on fourth postoperative day and may remain elevated for 6 weeks after instrumented spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Normal behavior of plasma procalcitonin in adolescents undergoing surgery for scoliosis

et al. 2014

View full text Add to dashboard Cite

Background and Aims: surgical site infections are relatively common after spinal deformity surgery. early detection of deep wound infections is important, since it may allow retention of spinal instrumentation. however, serum c-reactive protein and erythrocyte sedimentation rate may remain elevated for almost 6 weeks, making differential diagnosis of systemic inflammatory response and acute deep bacterial wound infection difficult. Plasma procalcitonin has been suggested to be a useful indicator for bacterial infection. however, there are no studies evaluating behavior of procalcitonin in patients undergoing major spine surgery with instrumentation.Materials and Methods: a total of 50 consecutive adolescents (37 idiopathic scoliosis and 13 neuromuscular scoliosis, mean age = 15 years at surgery and follow-up time = 21 months (range = 12-29 months)) undergoing scoliosis surgery participated in this prospective follow-up study. White blood cell count, serum c-reactive protein, and plasma procalcitonin levels were measured on the day before surgery, on the day of surgery, and daily thereafter for 1 week. None of the patients developed signs of acute or delayed wound infection during the follow-up period; however, two neuromuscular scoliosis patients developed severe postoperative pneumonia, and their inflammatory parameter data will be reported separately.Results: Plasma procalcitonin levels peaked on the first postoperative day (mean = 0.19 ng/ml, range = 0.04-1.29 ng/ml), and mean values were less than 0.5 ng/ml during the whole first postoperative week, while c-reactive protein remained elevated during the whole first postoperative week (highest mean value = 63.8 mg/l (range = 5-248 mg/l) on third postoperative day). Patients with idiopathic scoliosis had lower c-reactive protein levels (p < 0.05 from first to sixth postoperative day) and lower procalcitonin levels (p < 0.05 from third to seventh postoperative day) than neuromuscular scoliosis patients. two

show abstract

“…And so, papers regarding postoperative control of fusion surgery have been published. Some detailed reports have been published regarding the inflammatory reactions that occur after spinal instrumentation surgery (Takahashi et al 2001(Takahashi et al , 2006. Other reports have addressed the issues of bleeding volume and anemia following posterior fusion surgery (Behrman and Keim 1992;Gause et al 2008).…”

mentioning

confidence: 99%

Postoperative Anemia Following Posterior Decompression Surgery for Lumbar Spinal Canal Stenosis

Sasaji¹,

Horaguchi²,

Shinozaki³

et al. 2013

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

The incidence of lumbar spinal canal stenosis (LSCS) is increasing in Japan. Posterior lumbar decompression surgery, wide fenestration and laminectomy, for LSCS is a common treatment modality. Compared with posterior fusion surgery, posterior decompression surgery has been considered as less invasive. However, no reports regarding postoperative anemia following posterior decompression surgery have been published. In this retrospective study, we evaluated changes in hemoglobin values following wide fenestration in 80 patients with LSCS based on the number of operated levels, and also analyzed the differences between intraoperative and postoperative bleeding volume. Two patients required allogenic transfusion. The mean preoperative hemoglobin values were 13.6 g/dL and the mean postoperative minimum hemoglobin values were 11.2 g/dL. The mean hemoglobin values decreased by 1.8 g/dL in patients with one operated level (n = 15); 2.2 g/dL in those with two operated levels (n = 31); 2.6 g/dL in those with three operated levels (n = 23); and 3 g/dL in those with four operated levels (n = 11). The mean decrease in hemoglobin values was calculated as follows: 1.8 + 0.4 × (X − 1), where X was the number of operated levels. The mean intraoperative bleeding volume was 94 ml and the mean postoperative bleeding volume was 418 ml. Postoperative bleeding volume was significantly larger than intraoperative bleeding volume. Accordingly, postoperative hemoglobin values can be predicted in patients undergoing wide fenestration. Effective management of postoperative bleeding is necessary to prevent postoperative anemia.

show abstract

Usefulness of White Blood Cell Differential for Early Diagnosis of Surgical Wound Infection Following Spinal Instrumentation Surgery

Cited by 61 publications

References 8 publications

Infections in spinal instrumentation

Infections in spinal instrumentation

Normal behavior of plasma procalcitonin in adolescents undergoing surgery for scoliosis

Postoperative Anemia Following Posterior Decompression Surgery for Lumbar Spinal Canal Stenosis

Contact Info

Product

Resources

About