Evaluation of factors associated with postoperative infection following sacral tumor resection

Clinical article

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Object

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.

Methods

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.

Results

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.

Conclusions

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.

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Figures

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    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).

  • View in gallery

    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.

References

1

Bruns JFiedler WWerner MDelling G: Dedifferentiated chondrosarcoma—a fatal disease. J Cancer Res Clin Oncol 131:3333392005

2

Chugh RTawbi HLucas DRBiermann JSSchuetze SMBaker LH: Chordoma: the nonsarcoma primary bone tumor. Oncologist 12:134413502007

3

Fourney DRGokaslan ZL: Current management of sacral chordoma. Neurosurg Focus 15:2E92003

4

Fourney DRGokaslan ZL: Spinal instability and deformity due to neoplastic conditions. Neurosurg Focus 14:1E82003

5

Fourney DRRhines LDHentschel SJSkibber JMWolinsky JPWeber KL: En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine 3:1111222005

6

Gallia GLHaque RGaronzik IWitham TFKhavkin YAWolinsky JP: Spinal pelvic reconstruction after total sacrectomy for en bloc resection of a giant sacral chordoma. Technical note. J Neurosurg Spine 3:5015062005

7

Gallia GLSciubba DMBydon ASuk IWolinsky JPGokaslan ZL: Total L-5 spondylectomy and reconstruction of the lumbosacral junction. Technical note. J Neurosurg Spine 7:1031112007

8

Gerber SOllivier LLeclere JVanel DMissenard GBrisse H: Imaging of sacral tumours. Skeletal Radiol 37:277 2892008

9

Gokaslan ZL: Spine surgery for cancer. Curr Opin Oncol 8:1781811996

10

Gokaslan ZLRomsdahl MMKroll SSWalsh GLGillis TAWildrick DM: Total sacrectomy and Galveston L-rod reconstruction for malignant neoplasms. Technical note. J Neurosurg 87:7817871997

11

Guo YPalmer JLShen LKaur GWilley JZhang T: Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy. J Neurosurg Spine 3:1061102005

12

Guralnick MLBenouni SO'Connor RCEdmiston C: Characteristics of infections in patients undergoing staged implantation for sacral nerve stimulation. Urology 69:107310762007

13

Kelley SPAshford RURao ASDickson RA: Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J 16:4054092007

14

Kfoury HHaleem ABurgess A: Fine-needle aspiration biopsy of metastatic chordoma: case report and review of the literature. Diagn Cytopathol 22:1041062000

15

Mangram AJHoran TCPearson MLSilver LCJarvis WR: Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:971321999

16

Mangram AJHoran TCPearson MLSilver LCJarvis WR: Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:2502781999

17

Martin JJNiranjan AKondziolka DFlickinger JCLozanne KALunsford LD: Radiosurgery for chordomas and chondrosarcomas of the skull base. J Neurosurg 107:7587642007

18

Mindea SASalehi SAGanju ARosner MKO'Shaughnessy BAJorge A: Lumbosacropelvic junction reconstruction resulting in early ambulation for patients with lumbosacral neoplasms or osteomyelitis. Neurosurg Focus 15:2E62003

19

Olsen MAMayfield JLauryssen CPolish LBJones MVest J: Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:1491552003

20

Olsen MANepple JJRiew KDLenke LGBridwell KHMayfield J: Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90:62692008

21

Pant RYasko AWLewis VORaymond KLin PP: Chondrosarcoma of the scapula: long-term oncologic outcome. Cancer 104:1491582005

22

Perry JWMontgomerie JZSwank SGilmore DSMaeder K: Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 24:558 5611997

23

Sciubba DMChi JHRhines LDGokaslan ZL: Chordoma of the spinal column. Neurosurg Clin N Am 19:5152008

24

Weinstein MAMcCabe JPCammisa FP Jr: Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:4224262000

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