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. 2023 Jan;13(1):33-44.
doi: 10.1177/2192568221990647. Epub 2021 Feb 1.

Hypoalbuminemia and Elevated CRP are Risk Factors for Deep Infections and Urinary Tract Infections After Lumbar Spine Surgery in a Large Retrospective Patient Population

Brandon Yoshida  1 , Ailene Nguyen  1 , Blake Formanek  1 , Milad Alam  1 , Jeffrey C Wang  1 , Zorica Buser  1
Affiliations

Hypoalbuminemia and Elevated CRP are Risk Factors for Deep Infections and Urinary Tract Infections After Lumbar Spine Surgery in a Large Retrospective Patient Population

Brandon Yoshida et al. Global Spine J. 2023 Jan.

Abstract

Study design: Retrospective cross-sectional study.

Objectives: To determine if pre-operative albumin and CRP can predict post-operative infections after lumbar surgery.

Methods: Patients who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lumbar discectomy were identified using a patient record database (PearlDiver) and were included in this retrospective study. Patients were stratified by Charlson Comorbidity Index (CCI) scores and pre-operative albumin and CRP status. Post-operative complications included deep infections and urinary tract infections within 3 months of the surgery and revisions within 1 year of the surgery.

Results: 74,280 patients were included in this study. 21,903 had pre-operative albumin or CRP lab values. 7,191 (33%), 12,183 (56%), and 2,529 (12%) patients underwent an ALIF, PLIF, and a lumbar discectomy, respectively. 16,191 did not have any complication (74%). The most common complication was UTI (16%). Among all patients, hypoalbuminemia was a significant risk factor for deep infection and UTI after ALIF, deep infection, UTI, and surgical revision after PLIF, and deep infection after lumbar discectomy. Elevated CRP was a significant risk factor for deep infection after ALIF, UTI after PLIF, and deep infection after lumbar discectomy in patients with a CCI ≤ 3.

Conclusions: Pre-operative hypoalbuminemia and elevated CRP were significant risk factors for deep infection, UTI, and/or revision, after ALIF, PLIT, and/or lumbar discectomy. Future studies with a larger population of patients with low albumin and high CRP values are needed to further elaborate on the current findings.

Keywords: CRP; albumin; complications; lumbar; surgery.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Disclosures outside of submitted work: JCW- Royalties –Biomet, Seaspine, Amedica, Synthes; Investments/Options – Bone Biologics, Pearldiver, Electrocore, Surgitech; Board of Directors - AO Foundation, Society for Brain Mapping and Therapeutics, Fellowship Funding (paid to institution): AO Foundation ZB- consultancy: Cerapedics (past), The Scripps Research Institute, Xenco Medical (past), AO Spine (past); Research Support: SeaSpine (past, paid to the institution), Next Science (paid directly to institution), Motion Metrics (paid directly to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Research committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee- committee member.

Figures

Figure 1.
Figure 1.
Flow diagram of study design.
See this image and copyright information in PMC

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