Assessment Of Perioperative Outcomes After Intraoperative Irrigation In Single-segment Transforaminal Lumbar Interbody Fusion

Objective Thermal damage of local tissue is the main side effect while using the electric knife.Based on this reality we studied three strategies of interoperative irrigation and evaluate their effects to improve postoperative outcomes and the capabilities to prevent relative complications such as surgical site infection(SSI), offers surgeon a reference to choose their strategy of intreoperative irrigation.Method Both preoperative and postpoerative data of 139(59 male and 80 female) consecutive patients in our ward undertaken single segment transforaminal lumbar interbody fusion(TLIF) from March 2012 to March 2013 were recruited. Patients who had immune system disfunction resulting from diseases or undergoing immunosuppressive therapy during the perioperative period were expelled. Categorized all the cases into three groups as group A: simple irrigation before closure; group B: continuous intraoperative irrigation with saline and group C: continuous intraoperative irrigation with antibiotic solutions. The Centers for Disease Control and Prevention definition of surgical site infection was used [15]. All patients were followed up for more than 1 year. Differences were tested using the Student t-test for symmetrically distributed variables and the nonparametric Mann-whitney U test for those that were not.Result The univariate analysis showed good equilibrium characteristics between studied populations. Significant differences of blood loss, postoperative drainage of the first 24 hours, VAS scale of the wound after the first 24 hours, postoperative hospital stay are found significantly different between group A and B, A and C. The incensement of white blood cell counts was found significant different in group A while comparing with the other two groups. 3 cases in group A(6.12%), 1 case(2.04%) in group B and no case in group C were found positive evidence of SSI. All the infective cases were cured after aggressive surgical treatment and antibiotic therapy. SSI rates were found lower in group B and C when compared with group A, but no significant difference between any two of the three groups. Postoperative changes of CRP, CK and monocyte HLA-DR expression in group B and C are found milder than that of group A 24 hours after surgery, but there are no significant differences.Conclusion The continuous lavage with saline or antibiotic solution can significantly decrease the intraoperative estimated blood loss, postoperative drainage, and postoperative hospital stay. The average VAS of incision is significantly lower if cooling therapy conducted during operation. The significantly mild increase of white blood cell counts in group B and C suggest the use of antibiotics has the effect to alleviate the inflammatory reaction around the wound. Levels of other laboratory parameters such as CRP, HLA-DR and CK are proved to have a relatively mild change after continuous irrigation, which gives us clue that continuous irrigation during operation may have positive effect to improve the perioperative outcomes of patient. Although the association does not imply causation, we still recommend surgeon to control the perioperative temperature of local tissue by using continuous irrigation during operation at the sake of protecting local tissue and improving the outcomes.