Wound infection rates are generally higher in patients undergoing surgery for spinal metastasis. Risk factors of wound infection in these patients are poorly understood. PurposeTo identify demographic and clinical variables that may be associated with patients experiencing a higher wound infection rate. Study designRetrospective study with prospectively collected data of spinal metastasis patients operated consecutively at a University teaching hospital, adult spine division which is a tertiary referral centre for complex spinal surgery. Patient sampleNinety eight patients were all surgically treated, consecutively from January 2009 to September 2011. Three patients had to be excluded due to inadequate data.Outcome measures Physiologic measure, with presence or absence of microbiologically proven infection. MethodsVarious demographic and clinical data were recorded, including age, serum albumin level, blood total lymphocyte count, corticosteroid intake, Malnutrition Universal Screening Tool (MUST) score, neurological disability, skin closure material used, levels of surgery and administration of peri-operative corticosteroids. No funding was received from any sources for this study and as far as we are aware, there are no potential conflict of interest-associated biases in this study. ResultsHigher probabilities of infection were associated with low albumin level, 7 or more levels of surgery, use of delayed/non-absorbable skin closure material and presence of neurological disability. Of these factors, levels of surgery was found to be statistically significant at the 5% significance level. ConclusionsRisk of infection is high (17.9%) in patients undergoing surgery for spinal metastasis. Seven or more vertebral levels of surgery increases the risk of infection significantly (p‹0.05). Low albumin level, and presence of neurological disability appear to show a trend towards increased risk of infection. Use of absorbable skin closure material,age, low lymphocyte count, peri-operative administration of corticosteroids and MUST score do not appear to influence the risk of infection.

ObjectivesThe aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture.Patients and methodsPatients who underwent either dynamic hip screw (DHS) fixation (n = 74, mean age: 80 years) or hip hemiarthroplasty (n = 104, mean age: 84 years) for femoral neck fracture were included into the study. The hemoglobin level of the patients was monitored perioperatively.ResultsAnalysis found a statistically and clinically significant mean drop in hemoglobin of 31.1 g/L over time from pre-operatively (D0) to day-5 post-operatively (p < 0.001), with significant reductions from D0 to day-1 and day-1 to day-2 (p < 0.001). At each post-operative time point, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p = 0.046).ConclusionThe decrease in hemoglobin in the first 24-h post-operative period (D0 to day-1) is an underestimation of the ultimate lowest value in hemoglobin found at day-2. Relying on the day-1 hemoglobin could be detrimental to patient care. We propose a method of predicting patients likely to be transfused, and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.Level of evidenceLevel IV Prognostic study.

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