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

Publication ,  Journal Article
Carl, HM; Ahmed, AK; Abu-Bonsrah, N; De la Garza Ramos, R; Sankey, EW; Pennington, Z; Bydon, A; Witham, TF; Wolinsky, J-P; Gokaslan, ZL ...
Published in: J Neurosurg Spine
June 2018

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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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

June 2018

Volume

28

Issue

6

Start / End Page

663 / 668

Location

United States

Related Subject Headings

  • Surgical Wound
  • Spinal Neoplasms
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
 

Citation

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Carl, H. M., Ahmed, A. K., Abu-Bonsrah, N., De la Garza Ramos, R., Sankey, E. W., Pennington, Z., … Sciubba, D. M. (2018). Risk factors for wound-related reoperations in patients with metastatic spine tumor. J Neurosurg Spine, 28(6), 663–668. https://doi.org/10.3171/2017.10.SPINE1765
Carl, Hannah M., A Karim Ahmed, Nancy Abu-Bonsrah, Rafael De la Garza Ramos, Eric W. Sankey, Zachary Pennington, Ali Bydon, et al. “Risk factors for wound-related reoperations in patients with metastatic spine tumor.J Neurosurg Spine 28, no. 6 (June 2018): 663–68. https://doi.org/10.3171/2017.10.SPINE1765.
Carl HM, Ahmed AK, 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. J Neurosurg Spine. 2018 Jun;28(6):663–8.
Carl, Hannah M., et al. “Risk factors for wound-related reoperations in patients with metastatic spine tumor.J Neurosurg Spine, vol. 28, no. 6, June 2018, pp. 663–68. Pubmed, doi:10.3171/2017.10.SPINE1765.
Carl HM, Ahmed AK, Abu-Bonsrah N, De la Garza Ramos R, Sankey EW, Pennington Z, Bydon A, Witham TF, Wolinsky J-P, Gokaslan ZL, Sacks JM, Goodwin CR, Sciubba DM. Risk factors for wound-related reoperations in patients with metastatic spine tumor. J Neurosurg Spine. 2018 Jun;28(6):663–668.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

June 2018

Volume

28

Issue

6

Start / End Page

663 / 668

Location

United States

Related Subject Headings

  • Surgical Wound
  • Spinal Neoplasms
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Orthopedics
  • Middle Aged
  • Male
  • Humans