FACTORS INFLUENCING WOUND-HEALING AFTER SURGERY FOR METASTATIC DISEASE OF THE SPINE

Study Design, The study group consisted of 53 patients who underwent 7 5 operations for spine metastases. Patient and tumor demographic facto rs, preoperative nutritional status, and perioperative adjunctive ther apy were retrospectively reviewed. Objective, To determine the risk fa ctors for wound breakdown and infection in patients undergoing surgery for spinal metastases. Summary of Background Data. Spinal Fusion usin g spine implants may be associated with an infection rate of 5% or mor e. Surgery for spine metastases is associated with an infection rate o f more than 10%. Factors other than the type of surgery performed may account for the greater infection rate. Methods. Data were obtained by reviewing patient records. Age, sex, and neurologic status of the pat ient; tumor type and site; and surgical details were noted. Adjunctive treatment with corticosteroids and radiotherapy was recorded, Nutriti onal status was evaluated by determining serum protein and serum album in concentrations and by total lymphocyte count. Results. Wound breakd own and Infection occurred in 75 of 75 wounds. No patient or tumor dem ographic factors other than intraoperative blood loss (P < 0.1) were s tatistically associated with infection; The correlation between preope rative protein deficiency (P < 0.01) or perioperative corticosteroid a dministration (P < 0.10) and wound infection was significant. There wa s no statistical correlation between lymphocyte count or perioperative radiotherapy and wound infection. Conclusions, The results indicate t hat preoperative protein depletion and perioperative administration of corticosteroids are risk factors for wound infection in patients unde rgoing surgery for spine metastases, Perioperative correction of nutri tional depletion and cessation of steroid therapy may reduce wound com plications.