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Does preoperative prognostic nutrition index predict surgical site infection after spine surgery?

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Abstract

Purpose

Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, little is known about the relationship between SSI and the PNI in patients after spine surgery. We aimed to determine independent predictors of SSI after spine surgery.

Methods

We analyzed 1115 patients who underwent spine surgery (369 males, 746 females, mean age 56 years, follow-up period: at least 1 year). Patients were divided into SSI and non-SSI groups. Preoperative risk factors, including PNI (10 × serum albumin [g/dL] + 0.005 × total lymphocyte count [/μL]), were assessed.

Results

Postoperatively, 43 patients (3.9%) experienced SSI. Univariate analysis showed that preoperative PNI (48.5 vs 51.7; p < 0.01), revision status (p < 0.05), male sex (p < 0.01), body mass index (BMI) (p < 0.05), and usage of anticoagulant agents (p < 0.05) differed significantly between the SSI and non-SSI groups. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.90–0.98; p < 0.01), male sex (OR, 2.64; 95% CI: 1.40–4.99; p < 0.01), length of surgery ≥ 180 min (OR, 2.78; 95% CI: 1.30–5.96; p < 0.01), BMI ≥ 30 kg/m2 (OR, 2.89; 95% CI: 1.20–6.97; p < 0.05), and revision status (OR, 2.30; 95% CI: 1.07–4.98; p < 0.05) were independently associated with SSI postoperatively.

Conclusion

Lower preoperative PNI was found to be a risk factor for SSI after spine surgery. Patients with lower preoperative PNI values should be cautioned about the risk of SSI and provide adequate informed consent.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:149–155

    PubMed  Google Scholar 

  2. Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22:605–615. https://doi.org/10.1007/s00586-012-2514-6

    Article  PubMed  Google Scholar 

  3. de PesentiPannuAndres-BergosLafageSmithGlassmanKleuverPelliseSchwabLafageScoliosis Research STJRJSSMFFVS (2018) What are the risk factors for surgical site infection after spinal fusion? a meta-analysis. Eur Spine J 27:2469–2480. https://doi.org/10.1007/s00586-018-5733-7

    Article  Google Scholar 

  4. Peng XQ, Sun CG, Fei ZG, Zhou QJ (2019) Risk factors for surgical site infection after spinal surgery: a systematic review and meta-analysis based on twenty-seven studies. World Neurosurg 123:e318–e329. https://doi.org/10.1016/j.wneu.2018.11.158

    Article  PubMed  Google Scholar 

  5. Wang HX, Wang CC, Yang W, Gao LL, Yu SQ (2018) Prognostic value of preoperative prognostic nutritional index in stage III gastric cancer after curative resection: a retrospective cohort study. Asia Pac J Clin Nutr 27:540–545. https://doi.org/10.6133/apjcn.072017.03

    Article  PubMed  Google Scholar 

  6. Watanabe I, Kanauchi N, Watanabe H (2018) Preoperative prognostic nutritional index as a predictor of outcomes in elderly patients after surgery for lung cancer. Jpn J Clin Oncol 48:382–387. https://doi.org/10.1093/jjco/hyy014

    Article  PubMed  Google Scholar 

  7. Acarbas A (2019) A novel prognostic marker in patients undergoing spinal surgery: prognostic nutritional index. J Neurol Surg A Cent Eur Neurosurg 80:470–474. https://doi.org/10.1055/s-0039-1693031

    Article  PubMed  Google Scholar 

  8. Klein JD, Hey LA, Yu CS, Klein BB, Coufal FJ, Young EP, Marshall LF, Garfin SR (1996) Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine (Phila Pa 1976 ) 21:2676–2682. https://doi.org/10.1097/00007632-199611150-00018

    Article  CAS  Google Scholar 

  9. Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP Jr, Finerty EA, Nguyen JT, Gausden E, Sama AA (2011) Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Jt Surg Am 93:1627–1633. https://doi.org/10.2106/JBJS.J.00039

    Article  Google Scholar 

  10. Ogihara S, Yamazaki T, Maruyama T, Oka H, Miyoshi K, Azuma S, Yamada T, Murakami M, Kawamura N, Hara N, Terayama S, Morii J, Kato S, Tanaka S (2015) Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adults. J Orthop Sci 20:71–77. https://doi.org/10.1007/s00776-014-0669-1

    Article  PubMed  Google Scholar 

  11. Nunez-Pereira S, Rodriguez-Pardo D, Pellise F, Pigrau C, Bago J, Villanueva C, Caceres E (2014) Postoperative urinary tract infection and surgical site infection in instrumented spinal surgery: is there a link? Clin Microbiol Infect 20:768–773. https://doi.org/10.1111/1469-0691.12527

    Article  CAS  PubMed  Google Scholar 

  12. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol 20:250–278; quiz 279–280. https://doi.org/10.1086/501620

  13. Oe S, Togawa D, Yamato Y, Hasegawa T, Yoshida G, Kobayashi S, Yasuda T, Banno T, Arima H, Mihara Y, Ushirozako H, Yamada T, Matsuyama Y (2019) Preoperative age and prognostic nutritional index are useful factors for evaluating postoperative delirium among patients with adult spinal deformity. Spine (Phila Pa 1976) 44:472–478. https://doi.org/10.1097/BRS.0000000000002872

    Article  Google Scholar 

  14. Hu Q, Wang G, Ren J, Ren H, Li G, Wu X, Gu G, Li R, Guo K, Deng Y, Li Y, Hong Z, Wu L, Li J (2016) Preoperative prognostic nutritional index predicts postoperative surgical site infections in gastrointestinal fistula patients undergoing bowel resections. Medicine (Baltimore) 95:e4084. https://doi.org/10.1097/MD.0000000000004084

    Article  Google Scholar 

  15. Rao SB, Vasquez G, Harrop J, Maltenfort M, Stein N, Kaliyadan G, Klibert F, Epstein R, Sharan A, Vaccaro A, Flomenberg P (2011) Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis 53:686–692. https://doi.org/10.1093/cid/cir506

    Article  PubMed  Google Scholar 

  16. Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128

    CAS  PubMed  Google Scholar 

  17. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Jt Surg Am 90:62–69. https://doi.org/10.2106/JBJS.F.01515

    Article  Google Scholar 

  18. Hikata T, Iwanami A, Hosogane N, Watanabe K, Ishii K, Nakamura M, Toyama Y, Matsumoto M, Kamata M (2014) High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthop Sci 19:223–228. https://doi.org/10.1007/s00776-013-0518-7

    Article  CAS  PubMed  Google Scholar 

  19. Namba RS, Inacio MC, Paxton EW (2013) Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Jt Surgery American 95:775–782. https://doi.org/10.2106/JBJS.L.00211

    Article  Google Scholar 

  20. Maragakis LL, Cosgrove SE, Martinez EA, Tucker MG, Cohen DB, Perl TM (2009) Intraoperative fraction of inspired oxygen is a modifiable risk factor for surgical site infection after spinal surgery. Anesthesiology 110:556–562. https://doi.org/10.1097/ALN.0b013e3181974be7

    Article  PubMed  Google Scholar 

  21. Sasso RC, Garrido BJ (2008) Postoperative spinal wound infections. J Am Acad Orthop Surg 16:330–337. https://doi.org/10.5435/00124635-200806000-00005

    Article  PubMed  Google Scholar 

  22. Ahn DK, Park HS, Kim TW, Yang JH, Boo KH, Kim IJ, Lee HJ (2013) The degree of bacterial contamination while performing spine surgery. Asian Spine J 7:8–13. https://doi.org/10.4184/asj.2013.7.1.8

    Article  PubMed  PubMed Central  Google Scholar 

  23. Watanabe M, Sakai D, Matsuyama D, Yamamoto Y, Sato M, Mochida J (2010) Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation. J Neurosurg Spine 12:540–546. https://doi.org/10.3171/2009.11.SPINE09308

    Article  PubMed  Google Scholar 

  24. Kasliwal MK, Tan LA, Traynelis VC (2013) Infection with spinal instrumentation: review of pathogenesis, diagnosis, prevention, and management. Surg Neurol Int 4:S392–403. https://doi.org/10.4103/2152-7806.120783

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, Miyake M, Hama N, Miyamoto A, Ikeda M, Nakamori S, Sekimoto M, Fujitani K, Tsujinaka T (2015) Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 22(Suppl 3):S778–785. https://doi.org/10.1245/s10434-015-4820-9

    Article  PubMed  Google Scholar 

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Acknowledgements

We appreciate the help of Daisuke Togawa and Sho Kobayashi for case collections or manuscript discussions. We would like to thank Editage (www.editage.jp) for English language editing. Dr. Ushirozako was responsible for the study’s conception and design. Dr. Ushirozako acquired, analyzed, and interpreted data; drafted the article; and approved the final version on behalf of all authors. All authors critically revised the article and reviewed the submitted version. Dr. Matsuyama supervised the study.

Funding

No funding for this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Hiroki Ushirozako, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Yuki Mihara, Tomohiro Yamada, Koichiro Ide, Yuh Watanabe, Keichi Nakai & Yukihiro Matsuyama

  2. Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Yu Yamato & Shin Oe

  3. Department of Orthopaedic Surgery, Iwata City Hospital, Iwata, Shizuoka, Japan

    Tatsuya Yasuda

  4. Department of Orthopaedic Surgery, Omaezaki Municipal Hospital, Omaezaki, Shizuoka, Japan

    Takaaki Imada

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  1. Hiroki Ushirozako
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  2. Tomohiko Hasegawa
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  3. Yu Yamato
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  4. Go Yoshida
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  8. Shin Oe
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  15. Yukihiro Matsuyama
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Corresponding author

Correspondence to Hiroki Ushirozako.

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Conflict of interest

Dr. Oe and Yamato belong to a donation-funded laboratory called the “Division of Geriatric Musculoskeletal Health.” Donations to this laboratory have been received from Medtronic Sofamor Danek, Inc.; Japan Medical Dynamic Marketing, Inc.; and the Meitoku Medical Institution Jyuzen Memorial Hospital. The other authors declare no conflicts of interest.

Ethical approval

All study participants provided informed consent, and the study design was approved by the appropriate ethics review board of Hamamatsu University School of Medicine.

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Ushirozako, H., Hasegawa, T., Yamato, Y. et al. Does preoperative prognostic nutrition index predict surgical site infection after spine surgery?. Eur Spine J 30, 1765–1773 (2021). https://doi.org/10.1007/s00586-020-06622-1

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  • DOI: https://doi.org/10.1007/s00586-020-06622-1

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