Predictive Value of the Preoperative C-Reactive Protein-to-Albumin Ratio for Surgical Site Infection after Percutaneous Kyphoplasty: A Single-center Retrospective Study

Shuai Tang ¹ Wenhua Gong ¹ Hao Zhang ¹ Zheng Lian ¹ Xiaocui Han ² Shuo Han ^1*

• ¹ Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
• ² Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China

Objective: This study aimed to investigate the risk factors for surgical site infection (SSI) after percutaneous kyphoplasty (PKP) and evaluate the application value of the preoperative C-reactive protein (CRP)-to-albumin ratio (CAR) in predicting SSI.This study retrospectively enrolled 329 patients with thoracolumbar compression fractures who underwent PKP in the Affiliated Hospital of Qingdao University from January 2019 to June 2024. The demographic information, surgery-related data and laboratory examination results of the patients were collected. According to these results, the patients were divided into SSI and non-SSI groups, and the results were compared and analyzed. The receiver operating characteristic curve was used to determine the optimal cutoff value of preoperative CAR for predicting SSI, and binary logistic regression analysis was employed to evaluate the predictive value of CAR for SSI. The risk factors of SSI in the thoracolumbar subgroup were further explored.The study enrolled a total of 329 patients, and SSI occurred in 29 (8.81%). The optimal cut-off value of CAR was 0.1213, and the area under the curve was 0.808 (P < 0. 001). The results showed that SSI rates were related to the surgical site, and the SSI rate in the lumbar spine was higher than that in the thoracic spine. The SSI group had a longer surgical duration and more operated segments. The levels of preoperative CRP, CAR, procalcitonin and erythrocyte sedimentation rate (ESR) were higher; however, serum albumin levels were lower. More patients had CAR ≥0.1213 (75.86% vs 25.33%) and white blood cell (WBC) >10*10 9 (27.59% vs 10.00%). In addition, no significant differences were found by the other demographic data and laboratory examinations between the two groups. In the binary logistic regression analysis, preoperative CAR was an independent risk factor for post-PKP SSI, and the SSI risk increased by 7.464 times in patients with CAR ≥0.1213. The number of operated segments, surgical duration, and ESR were also independent risk factors for SSI, whereas serum albumin is a protective factor.Preoperative CAR is an effective predictor of post-PKP SSI, which can be used for clinical prevention and reduction of SSI risk.