Association of a polyester mesh-containing tissue adhesive system with early postoperative inflammatory biomarker profiles following instrumented thoracolumbar and lumbar fusion.

purposePolyester mesh-containing 2-octyl cyanoacrylate systems are increasingly used for skin closure after spinal surgery and can simplify postoperative wound care. However, whether their use is associated with a distinct early systemic inflammatory biomarker profile following instrumented fusion remains unclear. This study compared postoperative clinical events and early CRP and CRP-to-albumin ratio (CAR) profiles between a polyester mesh-containing tissue adhesive system and conventional closure.

methodsThis retrospective cohort study included 256 patients who underwent posterior instrumented thoracolumbar or lumbar fusion between January 2021 and July 2026. Conventional closure was used until May 2024 (n = 194), after which the tissue adhesive system was routinely adopted for eligible patients (n = 62). CRP, albumin, and CAR were assessed immediately postoperatively and at postoperative days (POD) 3 and 7. The full cohort was used for the primary analysis. Multivariable regression adjusted for demographic factors, major comorbidities, underlying diagnosis, and number of fused levels. A sensitivity analysis excluded patients with postoperative readmission and/or irrigation and debridement (I&D), and the relative reduction in CRP and CAR from POD 3 to POD 7 was evaluated.

resultsPostoperative readmission and reoperation requiring I&D did not differ significantly between groups, although event counts were low. Immediate postoperative CRP and CAR were comparable. At POD 3 and POD 7, the Tissue Adhesive Group had lower CRP (6.51 vs. 11.23 mg/dL and 3.21 vs. 6.05 mg/dL, respectively) and lower CAR (all P < 0.001). These associations remained significant after multivariable adjustment (POD 3 CRP adjusted mean difference, -4.29 mg/dL; 95% CI, -5.61 to -2.97; P < 0.001) and in the sensitivity analysis. In contrast, the percentage reduction from POD 3 to POD 7 did not differ significantly between groups for CRP (P = 0.655) or CAR (P = 0.516).

conclusionsUse of the polyester mesh-containing tissue adhesive system was associated with lower absolute CRP and CAR levels during the early postoperative period, but not with a faster relative decline from POD 3 to POD 7. These findings support an association with a lower early postoperative inflammatory biomarker profile; the clinical significance of this difference requires further prospective evaluation.