TY - JOUR
T1 - Risk factors for wound-related reoperations in patients with metastatic spine tumor
AU - Carl, Hannah M.
AU - Karim Ahmed, A.
AU - Abu-Bonsrah, Nancy
AU - De La Garza Ramos, Rafael
AU - Sankey, Eric W.
AU - Pennington, Zachary
AU - Bydon, Ali
AU - Witham, Timothy F.
AU - Wolinsky, Jean Paul
AU - Gokaslan, Ziya L.
AU - Sacks, Justin M.
AU - Rory Goodwin, C.
AU - Sciubba, Daniel M.
N1 - Publisher Copyright:
© AANS 2018, except where prohibited by US copyright law.
PY - 2018/6
Y1 - 2018/6
N2 - 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.
AB - 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.
KW - Infection
KW - Instrumentation failure
KW - Metastasis
KW - Oncology
KW - Reoperation
KW - Spine tumor
KW - Wound dehiscence
UR - http://www.scopus.com/inward/record.url?scp=85048135406&partnerID=8YFLogxK
U2 - 10.3171/2017.10.SPINE1765
DO - 10.3171/2017.10.SPINE1765
M3 - Article
C2 - 29547061
AN - SCOPUS:85048135406
SN - 1547-5654
VL - 28
SP - 663
EP - 668
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 6
ER -