Evaluation of factors associated with postoperative infection following sacral tumor resection

Clinical article

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Resection of sacral tumors has been shown to improve survival, since the oncological prognosis is commonly correlated with the extent of local tumor control. However, extensive soft-tissue resection in close proximity to the rectum may predispose patients to wound complications and infection. To identify potential risk factors, a review of clinical outcomes for sacral tumor resections over the past 5 years at a single institution was completed, paying special attention to procedure-related complications.


Between 2002 and 2007, 46 patients with sacral tumors were treated with surgery. Demographic data, details of surgery, type of tumor, and patient characteristics associated with surgical site infections (SSIs) were collected; these data included presence of the following variables: diabetes, obesity, smoking, steroid use, previous surgery, previous radiation, cerebrospinal fluid leak, number of spinal levels exposed, instrumentation, number of surgeons scrubbed in to the procedure, serum albumin level, and combined anterior-posterior approach. Logistic regression analysis was implemented to find an association of such variables with the presence of SSI.


A total of 46 patients were treated for sacral tumor resections; 20 were male (43%) and 26 were female (57%), with an average age of 46 years (range 11–83 years). Histopathological findings included the following: chordoma in 19 (41%), ependymoma in 5 (11%), rectal adenocarcinoma in 5 (11%), giant cell tumor in 4 (9%), and other in 13 (28%). There were 18 cases of wound infection (39%), and 2 cases of repeat surgery for tumor recurrence (1 chordoma and 1 giant cell tumor). Factors associated with increased likelihood of infection included previous lumbosacral surgery (p = 0.0184; odds ratio [OR] 7.955) and number of surgeons scrubbed in to the operation (p = 0.0332; OR 4.018). Increasing age (p = 0.0864; OR 1.031), presence of complex soft-tissue reconstruction (p = 0.118; OR 3.789), and bowel and bladder dysfunction (p = 0.119; OR 2.667) demonstrated a trend toward increased risk of SSI.


Patients undergoing sacral tumor surgery may be at greater risk for developing wound complications due to the extensive soft-tissue resections often required, especially with the increased potential for contamination from the neighboring rectum. In this study, it appears that previous lumbosacral surgery, number of surgeons scrubbed in, patient age, bowel and bladder dysfunction, and complex tissue reconstruction may predict those patients more prone to developing postoperative SSIs.

Abbreviations used in this paper: CSF = cerebrospinal fluid; OR = odds ratio; SSI = surgical site infection.

Article Information

Address correspondence to: Daniel M. Sciubba, M.D., Department of Neurosurgery, Johns Hopkins University, 600 North Wolfe Street, Meyer Building 8-161, Baltimore, Maryland 21287. email: dsciubb1@jhmi.edu.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Preoperative images of a 41-year-old man who underwent an intralesional resection for a sacral ependymoma and L3–ilium instrumented fusion. The lesions are shown on sagittal T2-weighted (A) and short-tau inversion recovery (B) views. Postoperatively the patient suffered from a persistent pseudomeningocele, viewed on sagittal T2-weighted MR imaging, and a CSF leak to the skin requiring lumboperitoneal shunting (C).

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    Images obtained in a 30-year-old woman who underwent a midsacral amputation for radical resection of a sacral chordoma and who suffered a postoperative infection that required debridement and wound revision by plastic surgery. Left: Preoperative sagittal T2-weighted MR imaging study showing hyperintense sacral chordoma. Right: Intraoperative photograph showing the large cavity left following sacral amputation, with S-2 nerve roots spared and rectum at the deep aspect of the wound.



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