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A Web-Based Calculator for Predicting the Occurrence of Wound Complications, Wound Infection, and Unplanned Reoperation for Wound Complications in Patients Undergoing Surgery for Spinal Metastases.

Publication ,  Journal Article
Hersh, AM; Feghali, J; Hung, B; Pennington, Z; Schilling, A; Antar, A; Patel, J; Ehresman, J; Cottrill, E; Lubelski, D; Elsamadicy, AA ...
Published in: World Neurosurg
November 2021

BACKGROUND: In the present study, we identified the risk factors for wound complications, wound infection, and reoperation for wound complications after spine metastasis surgery and deployed the resultant model as a web-based calculator. METHODS: Patients treated at a single comprehensive cancer center during a 7-year period were included. The demographics, pathology, comorbidities, laboratory values, and operative details were collected. Factors with P < 0.15 on univariable regression were entered into multivariable logistic regression to generate predictive models internally validated using 1000 bootstrapped samples. RESULTS: Of the 330 patients included, 29 (7.6%) had experienced a surgical site infection. The independent predictive factors for wound-related complications were a higher Charlson comorbidity index (CCI; odds ratio [OR], 1.41 per point; P < 0.01), Karnofsky performance scale score ≤70 (OR, 2.14; P = 0.04), lower platelet count (OR, 0.49 per 105/μL; P < 0.01), revision versus index surgery (OR, 3.10; P = 0.02), and increased incision length (OR, 1.21 per level; P = 0.02). Wound infection was associated with a higher CCI (OR, 1.60 per point; P < 0.01), a lower platelet count (OR, 0.35 per 105/μL; P < 0.01), revision surgery (OR, 4.63; P = 0.01), and a longer incision length (OR, 1.25 per level; P = 0.03). Unplanned reoperation for wound complications was predicted by a higher CCI (OR, 1.39 per point; P = 0.003), prior irradiation (OR, 2.52; P = 0.04), a lower platelet count (OR, 0.57 per 105/μL; P = 0.02), and revision surgery (OR, 3.34; P = 0.03), The optimism-corrected areas under the curve were 0.75, 0.81, and 0.72 for the wound complication, infection, and reoperation models, respectively. CONCLUSIONS: Low platelet counts, poorer health status, more invasive surgery, and revision surgery all independently predicted the risk of wound complications, including infection and unplanned reoperation for infection. Validation of the calculators in a prospective study is merited.

Duke Scholars

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

November 2021

Volume

155

Start / End Page

e218 / e228

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Spinal Neoplasms
  • Sensitivity and Specificity
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Middle Aged
  • Male
  • Internet
 

Citation

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Hersh, A. M., Feghali, J., Hung, B., Pennington, Z., Schilling, A., Antar, A., … Sciubba, D. M. (2021). A Web-Based Calculator for Predicting the Occurrence of Wound Complications, Wound Infection, and Unplanned Reoperation for Wound Complications in Patients Undergoing Surgery for Spinal Metastases. World Neurosurg, 155, e218–e228. https://doi.org/10.1016/j.wneu.2021.08.041
Hersh, Andrew M., James Feghali, Bethany Hung, Zach Pennington, Andy Schilling, Albert Antar, Jaimin Patel, et al. “A Web-Based Calculator for Predicting the Occurrence of Wound Complications, Wound Infection, and Unplanned Reoperation for Wound Complications in Patients Undergoing Surgery for Spinal Metastases.World Neurosurg 155 (November 2021): e218–28. https://doi.org/10.1016/j.wneu.2021.08.041.
Hersh AM, Feghali J, Hung B, Pennington Z, Schilling A, Antar A, Patel J, Ehresman J, Cottrill E, Lubelski D, Elsamadicy AA, Goodwin CR, Lo S-FL, Sciubba DM. A Web-Based Calculator for Predicting the Occurrence of Wound Complications, Wound Infection, and Unplanned Reoperation for Wound Complications in Patients Undergoing Surgery for Spinal Metastases. World Neurosurg. 2021 Nov;155:e218–e228.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

November 2021

Volume

155

Start / End Page

e218 / e228

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Spinal Neoplasms
  • Sensitivity and Specificity
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Middle Aged
  • Male
  • Internet