Predictive Value of Inflammatory, Nutritional, and Renal Markers for Surgical Site Infection-related Revision after Lumbar Fusion Surgery.

BACKGROUND

Early recognition of patients at risk for surgical site infection (SSI) after lumbar interbody fusion (LIF) may allow timely intervention. This study assessed the predictive value of inflammatory, nutritional, and renal markers for SSI-related revision surgeries.

METHODS

In this retrospective single-center study, 187 patients undergoing LIF were analyzed. C-reactive protein (CRP), leukocyte count, glomerular filtration rate (GFR), creatinine, and albumin were measured perioperatively. Patients requiring revision for SSI were compared with those without the need for revision surgery. Receiver operating characteristic (ROC) analysis was used to determine cut-offs, area under the curve (AUC), sensitivity, and specificity. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

RESULTS

SSI-related revision was required in 14.4% of patients. CRP peaked on postoperative day (POD) 3-4 in both groups but declined significantly only in non-revision cases (p < 0.0001). On POD 3-4, CRP > 111 mg/l predicted SSI (AUC = 0.72, 95%CI: 0.61-0.82, p = 0.012; OR = 3.48, 95%CI: 1.30-9.30, p = 0.013). Preoperative albumin was significantly lower in the SSI group (p = 0.004) with a predictive value on POD 1-2, when albumin < 33 g/l had the best discrimination (AUC = 0.74, 95%CI: 0.62-0.84, p = 0.04; OR = 4.15, 95% CI: 1.35-12.74, p = 0.038). The decline in GFR from baseline to POD 7-8 was significantly greater in group 1 (p = 0.021).

CONCLUSION

Persistent CRP elevation beyond POD 3-4, early postoperative hypoalbuminemia, and greater GFR decline identify patients at increased risk for SSI-related revision after LIF. Combined perioperative monitoring of inflammatory, nutritional, and renal markers may enable early risk stratification and targeted intervention.