Effect of hypostatic pneumonia and pleural effusion on the perioperative recovery of patients with thoracolumbar burst fracture: A retrospective study

Objective: Thoracolumbar burst fractures (TLBF) patients are often accompanied by hypostatic pneumonia (HP). The impact of HP on the perioperative outcomes of TLBF patients has not yet been reported. Moreover, the necessity of routine preoperative antibiotic use in TLBF patients with HP (TLBF-HP) remains unclear. This study aims to investigate the effect of HP on TLBF patients during the perioperative period, and explore the necessity of routine antibiotic application for TLBF-HP patients preoperatively. Methods: Patients diagnosed with single-segment TLBF who underwent posterior open pedicle screw and rod system fixation between May 2020 and Oct 2023 were included. Preoperative, intraoperative and postoperative data were extracted from the electronic patient record system retrospectively. The inflammatory status was evaluated by white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Intraoperative status was assessed via amount of blood loss and duration of surgery. Postoperative outcome was measured using duration of oxygen inhalation, duration of antibiotic use, length of stay, wound infection and ICU transfer.(I can confirm that all methods were performed in accordance with the relevant guidelines and regulations by including a statement in the methods section to this effect.) Results: Compared to patients without HP (TLBF-nHP), TLBF-HP patients had significantly higher rates of preoperative antibiotic use, longer duration of antibiotic use, longer postoperative duration of antibiotic therapy, and higher postoperative white blood cell counts ( p <0.01). Compared to patients without pleural effusion (TLBF-nPE), TLBF patients with PE (TLBF-PE) patients showed an increase in the rates and duration of preoperative antibiotic use ( p <0.01) and an increase in the duration of postoperative antibiotic therapy ( p <0.05). Among TLBF-HP patients who received preoperative antibiotics (TLBF-HP-BA), there was a greater amount of intraoperative blood loss ( p <0.05), longer surgical duration ( p <0.05), prolonged postoperative antibiotic use ( p <0.01), as well as a lower infection rate ( p <0.05) compared to those who did not receive preoperative antibiotics (TLBF-HP-nBA). Conclusion: Neither HP nor PE affects the perioperative status of TLBF patients significantly. Moreover, routine antibiotic application in TLBF-HP patients preoperatively may be unnecessary.