Postoperative Pancreatitis after Spinal Surgery and the Increased Risk of Sepsis and Wound Infection

a - The Nemours Foundation

Purpose: Acute pancreatitis is common between 3 and 7 days after posterior spinal fusion surgery for neuromuscular scoliosis. In view of the additional catabolic and inflammatory burden during the postoperative period and theoretical risk of bacterial translocation from adjacent bowel, infectious complications were reviewed in our patient population. The purpose of the study was to determine if postoperative pancreatitis increases a patient’s risk of developing an infection.

Methods: Eighty-seven children with neuromuscular scoliosis or idiopathic scoliosis undergoing posterior spinal fusion were enrolled in a prospective, IRB-approved study. Documented sepsis and deep wound infections with positive cultures requiring drainage were recorded.

Results: S: Eleven children of 87 developed clinical acute pancreatitis (>3 fold elevated amylase, elevated lipase and clinical features), and 6/87 had biochemical markers of pancreatitis only. None developed a pancreatic abscess. A total of 39 blood cultures were obtained. Sepsis was noted only in the neuromuscular group. Four out of six children who developed sepsis also had acute pancreatitis 1 - 5 days prior (p<0 .001. This reflects a 37% (95% CI 15%- 65%) rate of sepsis after pancreatitis. Coagulase negative Staphylococcus aureus (CNSA)(2), Enterococcus (1), and Candida (1) were identified. One case had E. coli also evidence prior biochemical Two additional cases positive CNSA cultures from the central line, but thought to be contaminants. Central lines required 1 - 6 days longer than average in 3 pancreatitis before was noted. Deep wound infection noted 8 patients. these associated with clinical acute (n.s.). However, included, 5/8 subsequent deep (P<0.01). No correlation urinary tract (5/87).

Conclusions: Postoperative acute pancreatitis is strongly associated with sepsis within a few days, suggesting a causal association. However, of the organisms, coagulase negative Staphylococcus aureus infections are unlikely to be related to translocation as a mechanism. The few extra days of use of central lines may account for some of this increase. Biochemical markers of acute pancreatitis with or without clinical features are associated with most cases of deep wound infection, as well as sepsis, suggesting subclinical pancreatitis may be an important risk factor. Further study is warranted to define this relationship.

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