Objective Early postoperative wound complications remain a significant challenge following posterior lumbar spine surgery. The C-reactive protein to albumin ratio (CAR) has emerged as a promising biomarker for systemic inflammation and nutritional status. This study aimed to evaluate the predictive value of preoperative CAR for postoperative wound complications in patients undergoing posterior lumbar spine surgery. Methods We retrospectively reviewed 420 patients who underwent posterior lumbar spine surgery at our institution. Patients were divided into a case group ( N = 140, with wound complications) and a control group ( N = 280, without wound complications). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for early postoperative wound complications. Subgroup analyses were further conducted based on surgical strategy (interbody fusion vs. without interbody fusion) and surgical extent (number of levels 3 vs. ≤ 3). Results Patients in the case group had significantly greater BMI, aCCI scores, ASA scores, blood loss, operative duration, and drain retention time compared to the control group (all P 0.05). The proportions of diabetes mellitus and allogeneic blood transfusion were also significantly higher in the case group compared to controls (all P 0.05). Notably, the proportion of patients with a high preoperative CAR (≥0.9) was significantly greater in the case group than in the control group (35.0% vs. 25.0%, P = 0.032). Multivariate logistic regression analysis revealed that a CAR ≥0.9 was an independent predictor of postoperative wound complications (fully adjusted OR: 1.753, 95% CI: 1.089–2.822, P = 0.021). In stratified analyses, CAR remained a robust predictor in patients undergoing interbody fusion (OR: 1.802, P = 0.011) and multilevel surgery (OR: 1.816, P = 0.010). However, CAR was not significantly associated with complications in patients undergoing surgery without interbody fusion ( P = 0.726). Conclusion Preoperative CAR is a valuable and independent biomarker for predicting early postoperative wound complications after posterior lumbar spine surgery. Its predictive utility is particularly significant in more complex procedures, such as interbody fusion and long-segment surgeries. Preoperative assessment of CAR may facilitate personalized risk stratification and clinical optimization to improve surgical outcomes.
Niu et al. (Thu,) studied this question.