Evaluation of the behavior of inflammatory parameters (ESR, CRP) in patients treated surgically due to spinal deformities

Abstract

Introduction. One of the most serious complications of elective surgery is the surgical site infection (SSI), especially in unburdened patients. It is believed that the parameters that may indicate such a process are, among others, C-reactive protein level (CRP) and erythrocyte sedimentation rate (ESR). Aim. The aim of the study is the daily assessment of changes in ESR and CRP values in patients after surgical correction of adolescent idiopathic scoliosis with posterior fusion, and their correlation with the occurrence of surgical site infection. Material and methods. The material is 45 consecutive patients, diagnosed with idiopathic scoliosis, treated surgically, in which in subsequent days after the operation the measurement of CRP and SR was performed. In this group, 4 patients needed surgical revision due to SSI. Results. The level of CRP protein increased in all patients, its highest value was on the second day after surgery and was on average 80 mg/l (2-144 mg/l) in the group without SSI and 58 mg/l (34-98 mg/l) in the group with SSI. In the following days CRP levels gradually declined, in the uncomplicated group it lowered to less than a half of the peak level at day 5 (mean 39 mg/l). In SSI group after a reduction of CRP values until day 4 we noted another peak to a mean value 65 mg/l (46-82) at day 7. ESR levels gradually increased and reached maximum values on day 5 in patients without SSI (43mm/h), and on day 6 in patients with SSI (52m/h). In patients with SSI, the changes of levels of ESR was not different from the other patients in whom the course of treatment was not complicated. Conclusions. The lack of reduction of CRP levels or a second rise of its levels may indicate increased risk of SSI. In this situation further steps to confirm this diagnosis should be carried out. The assessment of ESR after extensive spinal fusion surgery are not sufficient indicators to predict the risk of SSI.

Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery

“…However, none of these patients developed SSI 80 . In a cohort of AIS patients, 1 Level IV study reported that CRP levels peaked on postoperative day 2 for patients who did [mean 5.8 mg/dL (3.4to 9.8)] and did not [mean 8.0 mg/dL (range, 0.2 to 14.4)] develop wound infection, but patients with early SSI had a second peak [mean 6.5 mg/dL (4.6 to 8.2)] on day 7 81 . ESR levels, however, did not differ between patients with SSI and those without wound complications.…”