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Yamaguchi R, Tosaka M, Mukada N, Tsuneoka H, Shimauchi-Otaki H, Miyagishima T, Honda F, Yoshimoto Y. Postoperative Serum C-Reactive Protein and Cerebrospinal Fluid Leakage after Endoscopic Transsphenoidal Surgery. J Neurol Surg B Skull Base 2023; 84:578-584. [PMID: 37854533 PMCID: PMC10581823 DOI: 10.1055/a-1924-9736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022] Open
Abstract
Objective Postoperative cerebrospinal fluid (CSF) leakage in endoscopic transsphenoidal surgery is a potential risk that requires immediate repair. We investigated the potential of common postoperative hematological examinations for diagnosing postoperative CSF leakage. Methods We retrospectively studied 214 consecutive cases who underwent endoscopic transsphenoidal approach (ETSA; transsellar approach) or extended ETSA (E-ETSA). Patients with postoperative CSF leakage were defined the leak group (group L), and patients without were defined as the nonleak group (group N). Postoperative C-reactive protein (CRP) was compared between the ETSA and E-ETSA groups, and between the N and L groups. Results The values of white blood cell count and CRP 1 to 7 days after surgery were significantly higher in the L group. Especially, CRP was clearly elevated in the L group ( p < 0.001). The CRP value was higher in patients in the N group after E-ETSA than after ETSA ( p < 0.001). CRP increased on the day after surgery but decreased gradually thereafter in patients after ETSA and in the N group. In contrast, CRP value tended to increase gradually after surgery in the L group. In particular, the CRP on the day before the CSF leak was confirmed was clearly higher than on the fifth to seventh days in the N group. Conclusion Elevated CRP after endoscopic endonasal transsphenoidal surgery is a potential marker of CSF leakage.
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Affiliation(s)
- Rei Yamaguchi
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Tosaka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Naoto Mukada
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Haruka Tsuneoka
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroya Shimauchi-Otaki
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Fumiaki Honda
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Hiyama A, Sakai D, Nomura S, Katoh H, Watanabe M. Analysis of
cell‐free
circulating
DNA
fragment size and level in patients with lumbar canal stenosis. JOR Spine 2022; 5:e1189. [PMID: 35783906 PMCID: PMC9238277 DOI: 10.1002/jsp2.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Cell‐free circulating DNA (cfDNA), extracted by liquid biopsy, has been studied as a noninvasive biomarker for various diseases. The potential of cfDNA fragment size and level as a marker in lumbar canal stenosis (LCS) patients has never been studied. We investigated whether cfDNA is a biomarker of low back pain, leg pain, leg numbness severity in patients with an LCS. Blood samples were obtained from patients with LCS (n = 22) before and immediately after spinal surgery. Plasma DNA was isolated and examined for cfDNA fragment size and concentration. A cohort of healthy volunteers (n = 5) constituted the control group. The cfDNA fragment size tended to be shorter in patients than in healthy controls, but this difference was not significant (P = .186). cfDNA level was significantly higher in LCS patients (mean 0.614 ± 0.198 ng/μL, range 0.302‐1.150 ng/μL) than in healthy controls (mean 0.429 ± 0.064 ng/μL, range 0.366‐0.506 ng/μL) (P = .008). cfDNA level correlated positively with average pain (r = .435, P = .026) and leg numbness (r = .451, P = .018). cfDNA fragment size did not differ from before to after surgery, but cfDNA level increased postoperatively in patients with LCS. This was the first study investigating whether cfDNA fragment size and level are associated with pain in patients with LCS. Our findings suggest that cfDNA level may be an objective indicator of pain and surgical invasiveness in patients with LCS.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Surgical Science Tokai University School of Medicine Isehara Kanagawa Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science Tokai University School of Medicine Isehara Kanagawa Japan
| | - Satoshi Nomura
- Department of Orthopaedic Surgery, Surgical Science Tokai University School of Medicine Isehara Kanagawa Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Surgical Science Tokai University School of Medicine Isehara Kanagawa Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science Tokai University School of Medicine Isehara Kanagawa Japan
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Cohen LL, Birch CM, Cook DL, Hedequist DJ, Karlin LI, Emans JB, Hresko MT, Snyder BD, Glotzbecker MP. Variability in Antibiotic Treatment of Pediatric Surgical Site Infection After Spinal Fusion at A Single Institution. J Pediatr Orthop 2021; 41:e380-e385. [PMID: 33782367 DOI: 10.1097/bpo.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent focus on surgical site infections (SSIs) after posterior spine fusion (PSF) has lowered infection rates by standardizing perioperative antibiotic prophylaxis. However, efforts have neglected to detail antibiotic treatment of SSIs. Our aim was to document variability in antibiotic regimens prescribed for acute and latent SSIs following PSF in children with idiopathic, neuromuscular, and syndromic scoliosis. METHODS This study included patients who developed a SSI after PSF for scoliosis at a pediatric tertiary care hospital between 2004 and 2019. Patients had to be 21 years or younger at surgery. Exclusion criteria included growing rods, staged surgery, and revision or removal before SSI diagnosis. Infection was classified as acute (within 90 d) or latent. Clinical resolution of SSI was measured by return to normal lab values. Each antibiotic was categorized as empiric or tailored. RESULTS Eighty subjects were identified. The average age at fusion was 14.7 years and 40% of the cohort was male. Most diagnoses were neuromuscular (53%) or idiopathic (41%).Sixty-three percent of patients had an acute infection and 88% had a deep infection. The majority (54%) of subjects began on tailored antibiotic therapy versus empiric (46%). Patients with a neuromuscular diagnosis had 4.0 times the odds of receiving initial empiric treatment compared with patients with an idiopathic diagnosis, controlling for infection type and time (P=0.01). Ninety-two percent of patients with acute SSI retained implants at the time of infection and 76% retained them as of August 2020. In the latent cohort, 27% retained implants at infection and 17% retained them as of August 2020. CONCLUSIONS Patients with acute infections were on antibiotics longer than patients with latent infections. Those with retained implants were on antibiotics longer than those who underwent removal. By providing averages of antibiotic duration and lab normalization, we hope to standardize regimens moving forward and develop SSI-reducing pathways encompassing low-risk patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Lara L Cohen
- University of Miami Miller School of Medicine, Miami, FL
| | - Craig M Birch
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Danielle L Cook
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Lawrence I Karlin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - John B Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Michael T Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Brian D Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH
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Saul D, Hünicke P, Böker KO, Spering C, Maheshwari AK, Acharya M, Lehmann W. Predicting the disaster - The role of CRP in acetabular surgery. Clin Biochem 2021; 94:48-55. [PMID: 33895126 DOI: 10.1016/j.clinbiochem.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acetabular fractures represent a complex surgical challenge. Given the heterogenous fracture pattern, the patient characteristics and spectrum of complications demand individual solutions. Surgical site infections (SSI) threaten osteosynthesis, and early detection of them and treatment remain crucial. What is the value of postoperative C-reactive protein (CRP) in this group of patients as well as its normal course? DESIGN & METHODS 115 patients with isolated fractures of the acetabulum were retrospectively evaluated. CRP, white blood cell count (WBC) and fracture patterns as well as patient characteristics were assessed for 20 days following operative fixation of the acetabular fracture (n = 71) and in fractures that were managed conservatively (n = 44). RESULTS Twelve patients suffered an infectious complication. With a one-phase decay, 70.55% of the variance of postoperative CRP kinetics was predicted. To anticipate maximum CRP as well as an infection, the preoperative CRP represented the best prognostic parameter. To predict an infection, the single variable "peak CRP value above 100 mg/l" resulted in a sensitivity and specificity of 91.67% and 36.21%, respectively. Combining a second peak of CRP with maximum CRP and day 5 CRP value for receiver-operating characteristic (ROC) analysis resulted in 83.3% and 88.1%, respectively. CONCLUSIONS Predicting surgical site infections after an acetabular fracture is most predictive when analyzing the maximum overall CRP, the second peak and the CRP after day 5. With a combination of these parameters, a sensitivity and specificity of 83.3% and 88.1% to detect an infection was achieved.
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Affiliation(s)
- D Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany; Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA.
| | - P Hünicke
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
| | - K O Böker
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
| | - C Spering
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
| | - A K Maheshwari
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
| | - M Acharya
- Trauma & Orthopaedics, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - W Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
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Sharouf F, Hussain RN, Hettipathirannahelage S, Martin J, Gray W, Zaben M. C-reactive protein kinetics post elective cranial surgery. A prospective observational study. Br J Neurosurg 2019; 34:46-50. [PMID: 31645141 DOI: 10.1080/02688697.2019.1680795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Post cranial surgery readmission, largely caused by surgical site infection (SSI), is a marker of patient-care quality requiring comprehensive discharge planning. Currently, discharge assessment is based on clinical recovery and basic laboratory tests, including C-reactive protein (CRP). Although CRP kinetics have been examined postoperatively in a handful of papers, the validity of CRP as a standalone test to predict SSI is yet to be explored.Methods: A prospective observational study was performed on adult patients undergoing elective cranial surgery over a 3-month period. Laboratory data; CRP, white cell count (WCC), neutrophil cell count (NCC), and clinical data were assessed pre and post-operatively and were evaluated as predictors for safe discharge. Readmission rates within 1 month were recorded.Results: In this study, 68 patients were included. About 8.6% were readmitted due to SSI. A postoperativepeak in CRP was seen on day 2 with a value of 57 in the non-readmitted group, and 115 in the readmitted group. CRP dropped gradually to normal levels by day 5 in the non-readmitted group. A secondary CRP rise at day 5 was noted in the readmitted group with a sensitivity, specificity, and negative predictive value of 71%, 90%, and 96%, respectively. Interestingly, our ROC analysis indicates that a CRP value of less than 65 predicts safe discharge with a sensitivity of 86%, specificity of 89% and negative predictive value of 98% of safe discharge (area under the curve, AUC: 0.782). No significant difference in other inflammatory markers was found between both groups.Conclusions: CRP increases postoperatively for 4-5 d which could be a physiological response to surgery, however, prolonged elevation or a secondary increase in CRP may indicate an ongoing infection. Our data validate the potential use of CRP levels to predict SSI. A multicentre study is warranted to investigate the role of CRP in predicting SSI.
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Affiliation(s)
- Feras Sharouf
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK.,Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Rahim N Hussain
- Neuroscience and Mental Health Research Institute (NMHRI), School of Medicine, Cardiff University, Cardiff, UK
| | | | - John Martin
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK
| | - William Gray
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK.,Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Malik Zaben
- Department of Neuroscience, University Hospital of Wales (UHW), Cardiff, UK.,Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, School of Medicine, Cardiff University, Cardiff, UK
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Aljabi Y, Manca A, Ryan J, Elshawarby A. Value of procalcitonin as a marker of surgical site infection following spinal surgery. Surgeon 2018; 17:97-101. [PMID: 30055952 DOI: 10.1016/j.surge.2018.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/20/2018] [Accepted: 05/28/2018] [Indexed: 11/19/2022]
Abstract
AIM To compare the value of Procalcitonin (PCT) as a marker of surgical site infection to other inflammatory markers, including C-Reactive Protein (CRP), White Cell Count (WCC) and Erythrocyte Sedimentation Rate (ESR) in patients undergoing a number of spinal procedures. This study also aims to describe the biokinetic profile of the above-named markers in patients developing surgical site infection and those remaining infection-free post-operatively. METHODS 200 patients undergoing four routine elective spinal procedures were included for analysis. All patients had blood specimens taken at baseline, day 1, 2, 3, 4 and 5 post-operatively for analysis of PCT, CRP, ESR and WCC levels. All patients were monitored for early surgical site infection. Patients with other sources of infection in the early postoperative period were excluded. RESULTS Procalcitonin was the most sensitive and specific marker for the detection of surgical site infection in the immediate post-operative period with sensitivity and specificity of 100% and 95.2% respectively. Although Procalcitonin is an inflammatory marker, extent of surgical physiological insult did not alter its biokinetics as opposed to the other inflammatory markers making it a valuable marker of infection. CONCLUSION Procalcitonin was found to be superior to the other inflammatory markers investigated in this study as a marker for early surgical site infection in patients undergoing spinal surgery.
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Affiliation(s)
- Yasser Aljabi
- Department of Spinal Surgery, Tawam Hospital in affiliation with Johns Hopkins Medical, Al Ain, United Arab Emirates; Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland.
| | - Angelo Manca
- Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jessica Ryan
- Department of Orthopaedic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Amr Elshawarby
- Department of Spinal Surgery, Tawam Hospital in affiliation with Johns Hopkins Medical, Al Ain, United Arab Emirates
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[Postoperative C-reactive protein is a reliable marker to detect complications after radical cystectomy]. Prog Urol 2018; 28:282-290. [PMID: 29366634 DOI: 10.1016/j.purol.2017.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 11/27/2017] [Accepted: 12/31/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE Postoperative serum C-reactive protein (CRP) can be measured after major abdominal surgery to predict of complications at postoperative day (POD) 4. However, in urology, no studies have been conduced to analyze the role of CRP after radical cystectomy. The present study aims to analyze the relationship between a high postoperative level of CRP and the presence of complications after radical cystectomy for cancer. MATERIALS AND METHODS This multicenter retrospective study included 313 patients treated with radical cystectomy for cancer between January 2013 and July 2016. Among the patients, 57.5% of patients received urinary diversion using a Bricker ileal conduit, 30.5% an orthotropic ileal neobladder, and 11.5% had an ureterocutaneostomy. RESULTS Three hundred and thirteen patients were included (mean age 68.1±9.2 years). Among the patients, 26.5% had grade≥2 complications, according to the Clavien-Dindo classification. In multivariate analysis, only CRP level at POD 4 predicted the risk of a complication (P<0.001). CRP>150mg/L at POD 4 was strongly associated with a risk of a postoperative complication after a cystectomy (OR=81.42, 95% CI [25.6-258.3], P<0.001). CRP assessed on POD4 was reliable at ruling out the existence of an infectious complications with a negative predictive value of 0.94. The main limitation of our study was it observational design. CONCLUSIONS CRP at POD4 with a threshold of 150mg/L would reliably predict the risk of postoperative complications after cystectomy. Monitoring postoperative CRP could help adapt rehabilitation protocols after radical cystectomy and also the early management of complications.
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Linzer P, Filip M, Jurek P, Šálek T, Gajdoš M, Jarkovský J. Comparison of biochemical response between the minimally invasive and standard open posterior lumbar interbody fusion. Neurol Neurochir Pol 2016; 50:16-23. [DOI: 10.1016/j.pjnns.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
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Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery 2015; 157:362-80. [PMID: 25616950 DOI: 10.1016/j.surg.2014.09.009] [Citation(s) in RCA: 223] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 09/08/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Operative injury to the body from all procedures causes a stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute phase responses. This response has been examined commonly by the use of cortisol, interleukin-6 (IL-6), white cell count, and C-reactive protein (CRP). We aimed to determine which markers of the systemic inflammatory response were useful in determining the magnitude of injury after elective operations. METHODS A systematic review of the literature was performed using surgery, endocrine response, systemic inflammatory response, cortisol, IL-6, white cell count, and CRP. For each analyte the studies were grouped according to whether the operative injury was considered to be minor, moderate, or major and then by the operative procedure. RESULTS A total of 164 studies were included involving 14,362 patients. The IL-6 and CRP responses clearly were associated with the magnitude of operative injury and the invasiveness of the operative procedure. For example, the peak CRP response increased from 52 mg/L with cholecystectomy to 123 mg/L with colorectal cancer resection, 145 mg/L with hip replacement, 163 mg/L after abdominal aortic aneurysm repair, and 189 mg/L after open cardiac surgery. There also appeared to be a difference between minimally invasive/laparoscopic and open procedures such as cholecystectomy (27 vs 80 mg/L), colorectal cancer resection (97 vs 133 mg/L), and aortic aneurysm repair (132 vs 180 mg/L). CONCLUSION Peak IL-6 and CRP concentrations consistently were associated with the magnitude of operative injury and operative procedure. These markers may be useful in the objective assessment of which components of Enhanced Recovery after Surgery are likely to improve patient outcome and to assess the possible impact of operative injury on immune function.
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Affiliation(s)
- David G Watt
- Academic Unit of Colorectal Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland.
| | - Paul G Horgan
- Academic Unit of Colorectal Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Donald C McMillan
- Academic Unit of Colorectal Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland
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Kim JH, Ha SW, Choi JG, Son BC. Chronological Changes of C-Reactive Protein Levels Following Uncomplicated, Two-Staged, Bilateral Deep Brain Stimulation. J Korean Neurosurg Soc 2015; 58:368-72. [PMID: 26587192 PMCID: PMC4651999 DOI: 10.3340/jkns.2015.58.4.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The occurrence of acute cerebral infection following deep brain stimulation (DBS) is currently being reported with elevation of C-reactive protein (CRP) level. The aim of the present study was to establish normal range of the magnitude and time-course of CRP increases following routine DBS procedures in the absence of clinical and laboratory signs of infection. Methods A retrospective evaluation of serial changes of plasma CRP levels in 46 patients undergoing bilateral, two-staged DBS was performed. Because DBS was performed as a two-staged procedure involving; implantation of lead and internal pulse generator (IPG), CRP was measured preoperatively and postoperatively every 2 days until normalization of CRP (post-lead implantation day 2 and 4, post-IPG implantation day 2, 4, and 6). Results Compared with preoperative CRP levels (0.12±0.17 mg/dL, n=46), mean CRP levels were significantly elevated after lead insertion day 2 and 4 (1.68±1.83 mg/dL, n=46 and 0.76±0.38 mg/dL, n=16, respectively, p<0.001). The mean CRP levels at post-lead implantation day 2 were further elevated at post-IPG implantation day 2 (3.41±2.56 mg/dL, n=46, respectively, p<0.01). This elevation in post-IPG day 2 rapidly declined in day 4 (1.24±1.29 mg/dL, n=46, p<0.05) and normalized to preoperative value at day 6 (0.42±0.33 mg/dL, n=46, p>0.05). Mean CRP levels after IPG implantation were significantly higher in patients whose IPGs were implanted at post-lead day 3 than those at post-lead day 5-6 (3.99±2.80 mg/dL, n=30, and 2.31±1.56 mg/dL, n=16, respectively, p<0.05). However, there was no difference in post-IPG day 2 and 4 between them (p>0.05). Conclusion The mean postoperative CRP levels were highest on post-IPG insertion day 2 and decreased rapidly, returning to the normal range on post-IPG implantation day 6. The duration of post-lead implantation period influenced the magnitude of CRP elevation at post-IPG insertion day 2. Information about the normal response of CRP following DBS could help to avoid unnecessary diagnostic and therapeutic efforts.
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Affiliation(s)
- Jae-hun Kim
- Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-woo Ha
- Department of Neurosurgery, Chosun University Hospital, Chosum University College of Medicine, Gwangju, Korea
| | - Jin-gyu Choi
- Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-chul Son
- Department of Neurosurgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Santonocito C, De Loecker I, Donadello K, Moussa MD, Markowicz S, Gullo A, Vincent JL. C-Reactive Protein Kinetics After Major Surgery. Anesth Analg 2014; 119:624-629. [DOI: 10.1213/ane.0000000000000263] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Lombardi G, Grasso D, Berjano P, Banfi G, Lamartina C. Is Minimally Invasive Spine Surgery Also Minimally Pro-Inflammatory? Muscular Markers, Inflammatory Parameters and Cytokines to Quantify the Operative Invasiveness Assessment in Spine Fusion. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Over the last decades, minimally invasive surgery (MIS) techniques entered in the surgical routine due to their major advantage in reducing the unnecessary exposure of tissue and, thus, the trauma. Even in the context of orthopedics and spine surgery these practices have been widely developed and applied. Besides the clinical outcome of the patients, few studies have quantitatively assessed the traumatic and inflammatory effects of a specific surgical technique. Indeed, currently, a universally accepted biological outcome measure, such as a panel of biochemical markers, to define the success of MIS approach is still lacking. We reviewed the literature to collect the published data regarding the quantitative analysis of trauma induced by either conventional or minimally invasive surgery with the aim of highlighting evidence useful to guide future studies. Previous publications show some evidence in support of the hypothesis that MIS approaches are less traumatic, and possibly less pro-inflammatory, than conventional ones. Creatin kinase (as a marker of muscular damage) and C-reactive protein (as a marker of systemic inflammation) seem to reproducibly follow different trends in minimally invasive surgery compared to conventional procedures. Moreover, cytokines, such as interleukin (IL)-6 and IL-10 are also promising markers in this context.
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Affiliation(s)
- G. Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - D. Grasso
- Laboratory of Experimental Biochemistry and Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - P. Berjano
- O.U. Orthopaedics and Traumatology, Spine Surgery IV, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - G. Banfi
- Laboratory of Experimental Biochemistry and Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - C. Lamartina
- O.U. Orthopaedics and Traumatology, Spine Surgery II, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
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Klinger A, Buchfelder M, Schlaffer SM, Kremenevskaja N, Kleindienst A. Infection surveillance in transsphenoidal pituitary surgery - comparison of lipopolysaccharide-binding-protein, interleukin 6, C-reactive protein, white blood cell count, erythrocyte sedimentation rate and body temperature. Acta Neurochir (Wien) 2013; 155:2177-82; discussion 2182. [PMID: 24026232 DOI: 10.1007/s00701-013-1875-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/10/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND One of the major concerns in transsphenoidal surgery are infections because the approach to the pituitary includes a route of microbial colonization. To minimize the associated morbidity and mortality, a surveillance program is crucial to monitor for perioperative infections. METHODS For 1 year, we analysed body temperature (BT), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), C-reactive protein (CRP), interleukin 6 (IL-6) and lipopolysaccharide-binding-protein (LBP) following elective transsphenoidal pituitary surgery. Samples were collected on admission, day 1, 3 and 7 as well as 3 months postoperatively. RESULTS In 116 patients, all data were available. No postoperative infections occurred within the first postoperative week. BT (37.6 ± 0.6, baseline 37.0 ± 0.5 °C), WBC (11,366 ± 2,541, baseline 6,861 ± 2,123/μl), CRP (25.3 ± 22.6, baseline 3.1 ± 6 mg/l), IL-6 (12 ± 13, baseline 2.7 ± 2.6 pg/ml), and LBP (11.3 ± 4.9, baseline 5.7 ± 2.7 μg/ml) peaked on day 1 postoperatively (each p = 0.001), while ESR peaked on day 3 (25 ± 16, baseline 13 ± 11 mm/h, p = 0.001). BT and IL-6 normalized by day 3 and CRP by day 7, while ESR (23 ± 16 mm/h, p = 0.001), WBC (7,807 ± 2,750/μl, p = 0.001) and LBP (7.3 ± 2.6 μg/ml, p = 0.028) were still increased by day 7. CONCLUSION The present study establishes normative values for an infection surveillance following transsphenoidal pituitary surgery. CRP, a convenient and reasonable priced parameter, is affected by the procedure for the first postoperative week. IL-6 is more robust and allows a close monitoring on the expense of additional pricing. ESR, WBC and LBP are sustained affected by surgery, and do not offer any advantage. Since no infections were observed, we were unable to calculate the respective sensitivity and specificity.
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Woernle CM, Neidert MC, Wulf MA, Burkhardt JK, Grunwald T, Bernays RL. Excessively elevated C-reactive protein after surgery for temporal lobe epilepsy. Clin Neurol Neurosurg 2013; 115:1245-9. [DOI: 10.1016/j.clineuro.2012.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/30/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
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Marcus H, Nandi D. C-reactive protein in neurosurgery: valuable marker of post-operative infection or unnecessary over-investigation? Br J Neurosurg 2011; 25:788. [PMID: 22115020 DOI: 10.3109/02688697.2011.577919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alamri A, Saeed H, Kumar A, Crocker M, Bell BA. The true value of C-reactive protein measurement in neurosurgical patients. Br J Neurosurg 2011; 25:540-1. [DOI: 10.3109/02688697.2011.584640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Houten JK, Tandon A. Comparison of postoperative values for C-reactive protein in minimally invasive and open lumbar spinal fusion surgery. Surg Neurol Int 2011; 2:94. [PMID: 21748046 PMCID: PMC3130467 DOI: 10.4103/2152-7806.82575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/16/2011] [Indexed: 11/24/2022] Open
Abstract
Background: A major purported benefit of minimally-invasive spinal surgery (MIS) technique is less disruption of paraspinal soft tissues, but there is little quantifiable evidence of this in medical literature. Postoperative C-reactive protein (CRP) levels been shown to become more significantly elevated with larger surgical procedures, and this may allow for more measurable appreciation of any benefits of MIS verses open spinal surgery. Methods: CRP values were measured prior to and at multiple time points following surgery in patients undergoing posterior spinal fusion using both open and minimally invasive techniques. Results: Peak postoperative CRP was significantly lower in the 35 single-level minimally invasive procedures compared with the 11 single-level open procedures (13.5 vs. 21.3, P <0.01) and lower in the 12 two-level minimally invasive surgeries compared with 16 two-level open procedures (20.5 vs. 31.8, P <0.01). Conclusions: MIS lumbar fusion is associated with a lower peak in postoperative CRP compared with open surgery. This appears to support the notion that minimally invasive spine surgery technique leads to a measurable reduction in paraspinal soft tissue destruction mediated inflammation in the immediate postoperative period.
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Affiliation(s)
- John K Houten
- Department of Neurosurgery, Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, Bronx, NY, USA
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