Risk factors for wound-related reoperations in patients with metastatic spine tumor

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OBJECTIVE

Resection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.

METHODS

A retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.

RESULTS

A total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).

CONCLUSIONS

Although wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.

ABBREVIATIONS BMI = body mass index; CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; EBL = estimated blood loss; KPS = Karnofsky Performance Scale; RT = radiation therapy; VEGF = vascular endothelial growth factor; VTE = venous thromboembolism.

Article Information

Correspondence C. Rory Goodwin: Duke University Medical Center, Durham, NC. rory.goodwin@duke.edu.

INCLUDE WHEN CITING Published online March 16, 2018; DOI: 10.3171/2017.10.SPINE1765.

H.M.C., A.K.A., and N.A.B. contributed equally to this work.

Disclosures Mr. Ahmed had a Neurosurgery Research and Education Foundation (NREF) Medical Student Summer Research Fellowship. Dr. Goodwin is a United Negro College Fund (UNCF) Merck Postdoctoral Fellow and has received an award from the Burroughs Wellcome Fund, the NIH/NINDS Neurosurgeon Research Career Development Program (NRCDP) K12 Physician Scientist Award, and the North Carolina Spine Society. Dr. Bydon has a research grant from DePuy Spine and serves on the clinical advisory board of MedImmune, LLC. Dr. Witham receives support of a non–study-related clinical or research effort that he oversees in a grant from Eli Lilly and Co., and from the Gordon and Marilyn Macklin Foundation. Dr. Gokaslan has stock ownership in US Spine and Spinal Kinetics; receives consulting, speaking, and teaching fees from the AO Foundation; and receives research support from DePuy, NREF, AOSpine, and AO North America. Dr. Sacks has a consulting relationship with LifeCell, Inc. Dr. Sciubba has consulting relationships with Medtronic, Globus, DePuy-Synthes, Stryker, K2M, and NuVasive.

© AANS, except where prohibited by US copyright law.

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