Analysis of risk factors for early postoperative incisional infection after posterior lumbar surgery and the predictive value of CAR
Wang Huaren
Chen Jie
Yao Chuliang
Yang Yanxin
Liao Zhen
Du Jieming
Zhong Yongcong
Zeng Hui
Abstract：Objective To investigate the risk factors for early postoperative incisional infection after posterior lumbar surgery and the predictive value of the C-reactive protein(CRP)-to-albumin ratio(CAR),providing a reference for infection preven-tion.Methods A total of 756 patients who underwent posterior lumbar decompression with pedicle screw fixation at Guang-dong Armed Police Corps Hospital from December 2018 to December 2023 were enrolled.Among them,27 patients with in-cisional infections within 30 postoperative days were assigned to the infection group,while the remaining 729 patients com-prised the non-infection group.Clinical data were collected,and multivariate logistic stepwise regression was used to identify risk factors.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of CRP,albumin(ALB),and CAR for early infection.Results The incidence of early infection was 3.57%(27/756).Univariate analysis showed significant differences(P<0.05)in the infection group for:time of operation≥3 h,≥3 surgical segments,intrao-perative blood loss≥1 000 mL,interrupted suturing,drainage duration>5 days,and hypertension prevalence.No differ-ences were observed in sex,age,preoperative white blood cell count,lymphocyte count,hemoglobin levels,combined dia-betes,smoking history,or alcohol history(P>0.05).The infection group had higher CRP and CAR and lower ALB levels compared with the non-infection group(P<0.05).The AUCs(95%CI)for CRP,ALB,and CAR were 0.841(95%CI:0.796-0.886),0.719(95%CI:0.674-0.769),and 0.940(95%CI:0.895-0.985),respectively,with CAR demon-strating superior predictive value.Logistic stepwise regression analysis identified preoperative ALB<35.95 g/L(OR=2.026,95%CI:1.246-3.294),time of operation≥3 h(OR=1.732,95%CI:1.258-2.383),blood loss≥1 000 mL(OR=1.929,95%CI:1.281-2.906),and CAR≥0.70(OR=3.615,95%CI:1.953-6.689)as independent risk fac-tors(P<0.05).Conclusion Early incisional infection is strongly associated with elevated preoperative CAR.Additional risk factors include ALB<35.95 g/L,prolonged time of operation(≥3 h),and significant blood loss(≥1 000 mL).Pa-tients should be closely monitored for preoperative CAR and serum ALB levels clinically to achieve preoperative risk stratifi-cation management and reduce the risk of early postoperative incision infection.
Keywords：Posterior lumbar surgeryPostoperative infectionCRP-to-albumin ratioRisk factorsPredictive efficacy
Publication Date：2025-01-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 67-73 )