Abstract
Background
Early detection of surgical site infection (SSI) following spinal surgery would allow for prompt treatment and would improve overall outcome, yet early diagnosis is a challenge. Computed tomography (CT) guided aspiration of fluid collections may aid in diagnosis, as its diagnostic utility has previously been demonstrated in the setting of hip SSI, knee SSI, and spontaneous diskitis. There is no literature on its use in post-operative spinal SSIs.
Questions/Purposes
The current study aims to (1) determine the diagnostic value of CT-guided aspiration in evaluating suspected SSI; (2) identify the characteristics of the clinical presentation that are predictive of SSI; and (3) identify characteristics of the hematologic workup that are predictive of SSI.
Methods
Thirty patients who underwent CT-guided aspiration of paraspinal post-operative fluid collections and culture of aspirate fluid over the 6-year period from 2006 to 2011 were retrospectively reviewed. Aspirate fluid culture results were compared to intraoperative cultures, which were used as the “gold standard” for diagnosing SSI. The diagnostic value was evaluated by determining the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of aspirate fluid cultures. Clinical presentation, patient demographics, comorbidities, and laboratory values were reviewed for association with infection risk.
Results
Eleven of thirty patients undergoing CT-guided aspiration were subsequently confirmed to have SSI through positive cultures. Wound drainage, wound erythema, elevated ESR, and cloudiness of aspirate fluid were associated with SSI. The sensitivity and specificity of aspirate cultures were 36.4 and 89.5%, respectively, and the respective positive predictive value (PPV) and negative predictive value (NPV) were 66.7 and 70.8%.
Conclusions
Cloudy aspirate fluid was highly suggestive of infection, while wound erythema, drainage, and elevated ESR were also suggestive of SSI. CT-guided aspirations are a useful adjunct tool in evaluating for SSI but further studies are necessary before it can be considered a stand-alone diagnostic procedure.
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Jonathan E. Jo, MD, Andy O. Miller MD, Matthew R. Cohn, BS, Venu M. Nemani MD and Robert Schneider, MD have declared that they have no conflict of interest. Darren R. Lebl, MD reports other from Medtronic, K2M and Cohen and Company, outside the work.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [5].
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Informed consent was obtained from all patients for being included in the study.
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Level of Evidence: Diagnostic Study Level II. See Levels of Evidence for a complete description.
This work was performed at Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
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Jo, J.E., Miller, A.O., Cohn, M.R. et al. Evaluating the Diagnostic Yield of Computed Tomography-Guided Aspirations in Suspected Post-operative Spine Infections. HSS Jrnl 12, 119–124 (2016). https://doi.org/10.1007/s11420-016-9490-z
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DOI: https://doi.org/10.1007/s11420-016-9490-z