Evaluation of factors associated with postoperative infection following sacral tumor resection

Sciubba, Daniel M.; Nelson, Clarke; Gok, Beryl; McGirt, Matthew J.; McLoughlin, Gregory S.; Noggle, Joseph C.; Wolinsky, Jean Paul; Witham, Timothy F.; Bydon, Ali; Gokaslan, Ziya L.

doi:10.3171/spi.2008.9.0861

Cited by 57 publications

(49 citation statements)

References 26 publications

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“…Sacral procedures have had historically higher rates of infection than other spinal procedures [5][6][7][8][9][10]. Primary sacral tumors are rare, and experience with postoperative wound complications of these tumors is, therefore, limited to observations on less than 80 patients [2,[11][12][13][14][15][16][17][18]. The postoperative infection rates were 8.3-39.1 %.…”

Section: Discussionmentioning

confidence: 99%

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Experience with wound complications after surgery for sacral tumors

Guo

et al. 2013

Eur Spine J

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Purpose The aim of this article is to summarize our experience in treating sacral wound complications after sacrectomy. We focus, in particular, on factors associated with wound complications, including surgical site infection (SSI) and wound dehiscence. Methods The definition of SSI devised by Horgan et al. was applied. Wound dehiscence was defined as a wound showing breakdown in the absence of clinical signs meeting the diagnostic standard for SSI. Between September 1997 and August 2009, 387 patients with a sacral tumor underwent sacrectomy performed by the same team of surgeons and were followed up for C12 months. Potential risk factors were evaluated for univariate associations with SSI and wound complications. Multivariable conditional logistic regression was used to identify the combined effects of several risk factors. Results Of the 387 wounds studied, 274 healed uneventfully, and 113 (29.2 %) broke down because of infection or dehiscence. Fifty-one (13.2 %) patients developed a postoperative SSI, and 62 (16.0 %) patients developed wound dehiscence. Gram-negative bacteria grew in 45 cultures (91.8 %) and included 38 cases of Escherichia coli. Previous radiation, rectum rupture, longer duration of surgery, and cerebrospinal fluid leakage were significantly associated with increased likelihood of developing an SSI. Previous radiation, rectum rupture, age \40 years, history of diabetes mellitus, maximum tumor diameter C10 cm, and instrumentation used were risk factors for wound complications. Conclusions The incidence of wound complications is not so high at a musculoskeletal tumor center with surgeons experienced in treating sacral tumors. Controlling for these risk factors when possible may improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

“…One of the aims of our study was to define the significant factors that contribute to an increased incidence of wound complications. As in most studies, we selected SSI as the dependent variable [10,13]. Wound dehiscence, which is also a major wound complication, also occurred frequently in this series of patients.…”

Section: Discussionmentioning

confidence: 99%

Experience with wound complications after surgery for sacral tumors

Guo

et al. 2013

Eur Spine J

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“…Five additional potentially relevant studies were identified from reference lists. Of the 34 articles that underwent full-text review, 12 [22][23][24][25][26][27][28][29][30][31][32][33] met eligibility criteria for inclusion in the meta-analysis and 22 were excluded. The most common reasons for exclusion of the 22 studies were: criteria for the diagnosis of SSI not reported and/or CDC/NNIS criteria not applied [34][35][36][37][38][39][40][41][42][43][44][45][46][47], non-scalar definitions of obesity used [47][48][49], risk estimates of the association between obesity/BMI and SSI not reported or raw data not provided to calculate risks [44,47,[50][51][52][53], and analyses restricted to deep wound infections [54,55].…”

Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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Purpose Inconsistent results have been reported in the literature on the association between obesity, expressed as increased body mass index (BMI), and risk for surgical site infection (SSI) following spine surgery. The objective of this study was to review and quantify the association between increased BMI and risk of spinal SSI in adults. Methods We performed a comprehensive search for relevant studies using PubMed, Embase, and references of published manuscripts. Study-specific risk measures were transformed into slope estimates and combined using the random effects meta-analysis model to establish the risk of SSI associated with every 5-unit increase in BMI. Results Thirty-four articles underwent full-text review. Variations were noted among these studies in relation to SSI diagnosis criteria and BMI cut-off levels used to define obesity. Data from 12 retrospective studies were included in the analyses. Results showed that BMI was significantly positively associated with the risk of spinal SSI. Unadjusted risk estimates demonstrated that a 5-unit increase in BMI was associated with 13 % increased risk of SSI [Crude odds ratio (OR): 1.13; 95 % CI: 1.07-1.19, p\ 0.0001]. Pooling of risk estimates adjusted for diabetes and other confounders resulted in a 21 % increase in risk of spinal SSI for every 5-unit increase in BMI (adjusted OR: 1.21; 95 % CI 1.13-1.29, p \ 0.0001). ConclusionHigher BMI is associated with the increased risk of SSI following spine surgery. Prospective studies are needed to confirm this association and to determine whether other measures of fat distribution are better predictors of risk of SSI.

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“…[34][35][36][46][47][48]50,52,65,67,68,78,80,81,[86][87][88]95,100 It is especially important to understand the incidence and predictive factors for adverse events in spinal oncology patients, as a single complication may be associated with morbidity, mortality, and costs. 1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, 48,52,65,74,86,93,98 and prior studies have identified anatomical location, tumor size, tumor histology, extent of resection, surgical approaches, age, functional status, comorbidities, preoperative medication (steroid use, morphine), longer operative time, insurance status, early postoperative complications, and adjuvant chemotherapy and radiotherapy as factors associated with postoperative morbidity and mortality. 1,[18][19][20][21][22][23]…”

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confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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Evaluation of factors associated with postoperative infection following sacral tumor resection

Cited by 57 publications

References 26 publications

Experience with wound complications after surgery for sacral tumors

Experience with wound complications after surgery for sacral tumors

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

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