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.
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.
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).
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.
Correspondence C. Rory Goodwin: Duke University Medical Center, Durham, NC. firstname.lastname@example.org.
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.
BuerbaRAFuMCGruskayJALongWDIIIGrauerJN: Obese Class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS NSQIP database. Spine J14:2008–20182014
BuerbaRA, FuMC, GruskayJA, LongWDIII, GrauerJN: Obese Class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS NSQIP database. 14:2008–2018, 20142431611810.1016/j.spinee.2013.11.047)| false
ChiengLO, HubbardZ, SalgadoCJ, LeviAD, ChimH: Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review. 39(4):E17, 201510.3171/2015.7.FOCUS1524526424341)| false
CoxJB, WeaverKJ, NealDW, JacobRP, HohDJ: Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis: Clinical article. 21:677–684, 20142510533710.3171/2014.6.SPINE13447)| false
De la Garza RamosRGoodwinCRJainAAbu-BonsrahNFisherCGBettegowdaC: Development of a metastatic spinal tumor frailty index (MSTFI) using a nationwide database and its association with inpatient morbidity, mortality, and length of stay after spine surgery. World Neurosurg95:548–555555.e1–555.e42016
De la Garza RamosR, GoodwinCR, JainA, Abu-BonsrahN, FisherCG, BettegowdaC, : Development of a metastatic spinal tumor frailty index (MSTFI) using a nationwide database and its association with inpatient morbidity, mortality, and length of stay after spine surgery. 95:548–555, 555.e1–555.e4, 201610.1016/j.wneu.2016.08.029)| false
De la Garza RamosRJainANakhlaJNasserRPuvanesarajahVHassanzadehH: Postoperative morbidity and mortality after elective anterior cervical fusion in patients with chronic and end-stage renal disease. World Neurosurg95:480–4852016
De la Garza RamosR, JainA, NakhlaJ, NasserR, PuvanesarajahV, HassanzadehH, : Postoperative morbidity and mortality after elective anterior cervical fusion in patients with chronic and end-stage renal disease. 95:480–485, 201610.1016/j.wneu.2016.06.096)| false
FerresMA, OlivarezSA, TrinhV, DavidsonC, Sangi-HaghpeykarH, Aagaard-TilleryKM: Rate of wound complications with enoxaparin use among women at high risk for postpartum thrombosis. 117:119–124, 20112117365210.1097/AOG.0b013e3182029180)| false
FlexmanAM, Charest-MorinR, StobartL, StreetJ, RyersonCJ: Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease. 16:1315–1323, 20162737411010.1016/j.spinee.2016.06.017)| false
GarveyPB, RhinesLD, DongW, ChangDW: Immediate soft-tissue reconstruction for complex defects of the spine following surgery for spinal neoplasms. 125:1460–1466, 201010.1097/PRS.0b013e3181d5125e20134362)| false
LevitanNDowlatiARemickSCTahsildarHISivinskiLDBeythR: Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine (Baltimore)78:285–2911999
LevitanN, DowlatiA, RemickSC, TahsildarHI, SivinskiLD, BeythR, : Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. 78:285–291, 199910.1097/00005792-199909000-0000110499070)| false
MesfinASciubbaDMDeaNNaterABirdJEQuraishiNA: Changing the adverse event profile in metastatic spine surgery: an evidence-based approach to target wound complications and instrumentation failure. Spine (Phila Pa 1976)41 (Suppl20):S262–S2702016
MesfinA, SciubbaDM, DeaN, NaterA, BirdJE, QuraishiNA, : Changing the adverse event profile in metastatic spine surgery: an evidence-based approach to target wound complications and instrumentation failure. 41 (Suppl20):S262–S270, 2016)| false
OmeisIADhirMSciubbaDMGottfriedONMcGirtMJAttenelloFJ: Postoperative surgical site infections in patients undergoing spinal tumor surgery: incidence and risk factors. Spine (Phila Pa 1976)36:1410–14192011
SebastianASCurrierBLClarkeMJLarsonDHuddlestonPMIIINassrA: Thromboembolic disease after cervical spine surgery: a review of 5,405 surgical procedures and matched cohort analysis. Global Spine J6:465–4712016
SindaliKRoseBSoueidHJeerPSaranDShrivastavaR: Elective hip and knee arthroplasty and the effect of rivaroxaban and enoxaparin thromboprophylaxis on wound healing. Eur J Orthop Surg Traumatol23:481–4862013
SindaliK, RoseB, SoueidH, JeerP, SaranD, ShrivastavaR: Elective hip and knee arthroplasty and the effect of rivaroxaban and enoxaparin thromboprophylaxis on wound healing. 23:481–486, 20132341229310.1007/s00590-012-0987-y)| false
WiseJJ, FischgrundJS, HerkowitzHN, MontgomeryD, KurzLT: Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. 24:1943–1951, 199910.1097/00007632-199909150-0001410515021)| false