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

Hannah M. Carl, A. Karim Ahmed, Nancy Abu-Bonsrah, Rafael De La Garza Ramos, Eric W. Sankey, Zachary Pennington, Ali Bydon, Timothy F Witham, Jean Paul Wolinsky, Ziya L. Gokaslan, Justin Michael Sacks, C. Rory Goodwin, Daniel Sciubba

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)663-668
Number of pages6
JournalJournal of Neurosurgery: Spine
Volume28
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Reoperation
Spine
Wounds and Injuries
Neoplasms
Surgical Wound Infection
Adjuvant Radiotherapy
Venous Thromboembolism
Wound Infection
Hyperlipidemias
Comorbidity
Hospitalization
Multivariate Analysis
Retrospective Studies
Smoking
Quality of Life
Hypertension
Morbidity
Costs and Cost Analysis
Pain

Keywords

  • Infection
  • Instrumentation failure
  • Metastasis
  • Oncology
  • Reoperation
  • Spine tumor
  • Wound dehiscence

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Carl, H. M., Karim Ahmed, A., Abu-Bonsrah, N., De La Garza Ramos, R., Sankey, E. W., Pennington, Z., ... Sciubba, D. (2018). Risk factors for wound-related reoperations in patients with metastatic spine tumor. Journal of Neurosurgery: Spine, 28(6), 663-668. https://doi.org/10.3171/2017.10.SPINE1765

Risk factors for wound-related reoperations in patients with metastatic spine tumor. / Carl, Hannah M.; Karim Ahmed, A.; Abu-Bonsrah, Nancy; De La Garza Ramos, Rafael; Sankey, Eric W.; Pennington, Zachary; Bydon, Ali; Witham, Timothy F; Wolinsky, Jean Paul; Gokaslan, Ziya L.; Sacks, Justin Michael; Rory Goodwin, C.; Sciubba, Daniel.

In: Journal of Neurosurgery: Spine, Vol. 28, No. 6, 01.06.2018, p. 663-668.

Research output: Contribution to journalArticle

Carl, HM, Karim Ahmed, A, Abu-Bonsrah, N, De La Garza Ramos, R, Sankey, EW, Pennington, Z, Bydon, A, Witham, TF, Wolinsky, JP, Gokaslan, ZL, Sacks, JM, Rory Goodwin, C & Sciubba, D 2018, 'Risk factors for wound-related reoperations in patients with metastatic spine tumor', Journal of Neurosurgery: Spine, vol. 28, no. 6, pp. 663-668. https://doi.org/10.3171/2017.10.SPINE1765
Carl HM, Karim Ahmed A, Abu-Bonsrah N, De La Garza Ramos R, Sankey EW, Pennington Z et al. Risk factors for wound-related reoperations in patients with metastatic spine tumor. Journal of Neurosurgery: Spine. 2018 Jun 1;28(6):663-668. https://doi.org/10.3171/2017.10.SPINE1765
Carl, Hannah M. ; Karim Ahmed, A. ; Abu-Bonsrah, Nancy ; De La Garza Ramos, Rafael ; Sankey, Eric W. ; Pennington, Zachary ; Bydon, Ali ; Witham, Timothy F ; Wolinsky, Jean Paul ; Gokaslan, Ziya L. ; Sacks, Justin Michael ; Rory Goodwin, C. ; Sciubba, Daniel. / Risk factors for wound-related reoperations in patients with metastatic spine tumor. In: Journal of Neurosurgery: Spine. 2018 ; Vol. 28, No. 6. pp. 663-668.
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abstract = "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.",
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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 Michael

AU - Rory Goodwin, C.

AU - Sciubba, Daniel

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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

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