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European Spine Journal

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01-04-2016 | Original Article

Risk factors for surgical site infection after posterior fixation surgery and intraoperative radiotherapy for spinal metastases

Authors: Shurei Sugita, Takahiro Hozumi, Kiyofumi Yamakawa, Takahiro Goto, Taiji Kondo

Published in: European Spine Journal | Issue 4/2016

Abstract

Purpose

Posterior surgery with intraoperative radiotherapy for spinal metastases offers effective therapy, as we have reported previously. However, the procedure involves transfer from the operating room to the radiotherapy room, and as these patients are somewhat immunocompromised, the risk of postoperative surgical site infection (SSI) may be increased. The aim of our study was to identify risk factors and patient characteristics associated with postoperative SSI following posterior fixation surgery and intraoperative radiotherapy for spinal metastases.

Methods

Participants comprised 279 patients who underwent IORT for the treatment of spinal metastases between August 2004 and June 2013. Patients who suffered SSI within 1 month after surgery were categorized as infected, and all others were categorized as non-infected. We compared factors of age, sex, use of pre-operative corticosteroid, medical history of diabetes, prognosis scores (Tomita, Tokuhashi, and Katagiri), pre- and postoperative Frankel scale scores, site of tumor origin, administration of pre-operative radiotherapy, operation time, intraoperative blood loss, intraoperative irradiation dose, and pre- and postoperative performance status between groups.

Results

SSI occurred in 41 patients (14.7 %). Katagiri’s and Tokuhashi’s prognostic scores (P < 0.05 each), postoperative Frankel scale score (P < 0.01), administration of pre-operative radiotherapy (P < 0.05), and postoperative performance status (P < 0.05) all correlated significantly with occurrence of SSI. Multivariate analysis using those factors revealed administration of pre-operative radiotherapy as a factor independently associated with SSI (P < 0.05).

Conclusions

Patient prognosis, postoperative ambulatory function, and pre-operative radiotherapy were risk factors for SSI in patients with spinal metastases. Duration of surgery and intraoperative blood loss were not associated with occurrence of SSI.

Ortiz Gomez JA (1995) The incidence of vertebral body metastases. Int Orthop 19:309–311CrossRefPubMed

Black P (1979) Spinal metastasis: current status and recommended guidelines for management. Neurosurgery 5:726–746CrossRefPubMed

Saito T, Kondo T, Hozumi T, Karasawa K, Seichi A, Nakamura K (2006) Results of posterior surgery with intraoperative radiotherapy for spinal metastases. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 15:216–222. doi:10.1007/s00586-005-0979-2 CrossRef

Seichi A, Kondoh T, Hozumi T, Karasawa K (1999) Intraoperative radiation therapy for metastatic spinal tumors. Spine 24:470–475CrossRefPubMed

Demura S, Kawahara N, Murakami H, Nambu K (2009) Surgical site infection in spinal metastasis risk factors and countermeasures. Spine 34:635–639CrossRefPubMed

McPhee IB, Williams RP, Swanson CE (1998) Factors influencing wound healing after surgery for metastatic disease of the spine. Spine 23:726–732 (discussion 732–723) CrossRefPubMed

Saunders L, Perennec-Olivier M, Jarno P, L’Hériteau F, Venier A-G, Simon L, Giard M, Thiolet J-M, Viel J-F (2014) Improving prediction of surgical site infection risk with multilevel modeling. PLoS One 9:e95295. doi:10.1371/journal.pone.0095295 CrossRefPubMedPubMedCentral

Quraishi NA, Rajabian A, Spencer A, Arealis G, Mehdian H, Boszczyk BM, Edwards KL (2015) Re-operation rates in the surgical treatment of spinal metastases. Spine J. doi:10.1016/j.spinee.2015.01.005

Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26:298–306CrossRef

10.

Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 15:1110–1113CrossRef

11.

Katagiri H, Takahashi M, Wakai K, Sugiura H, Kataoka T, Nakanishi K (2005) Prognostic factors and a scoring system for patients with skeletal metastasis. J Bone Joint Surg Br 87:698–703. doi:10.1302/0301-620X.87B5.15185 CrossRefPubMed

12.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern cooperative oncology group. Am J Clin Oncol 5:649–655CrossRefPubMed

13.

Sherman SI (2003) Thyroid carcinoma. Lancet 361:501–511CrossRefPubMed

14.

Murakami H, Kawahara N, Yahata T, Yokoyama K, Komai K, Tomita K (2006) Radiation myelopathy after radioactive iodine therapy for spine metastasis. Br J Radiol 79:e45–e49. doi:10.1259/bjr/16265478 CrossRefPubMed

15.

Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:149–155PubMed

16.

Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90:62–69. doi:10.2106/JBJS.F.01515 CrossRefPubMed

17.

Wise JJ, Fischgrund JS, Herkowitz HN (1999) Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine 24:1943–1951CrossRefPubMed

18.

Ghogawala Z, Mansfield FL, Borges LF (2001) Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976) 26:818–824CrossRef

19.

Sundaresan N, Rothman A, Manhart K, Kelliher K (2002) Surgery for solitary metastases of the spine: rationale and results of treatment. Spine (Phila Pa 1976) 27:1802–1806CrossRef

20.

Bernstein EF, Sullivan FJ, Mitchell JB, Salomon GD, Glatstein E (1993) Biology of chronic radiation effect on tissues and wound healing. Clin Plast Surg 20:435–453PubMed

21.

Ariyan S, Kraft RL, Goldberg NH (1980) An experimental model to determine the effects of adjuvant therapy on the incidence of postoperative wound infection: II. Evaluating preoperative chemotherapy. Plast Reconstr Surg 65:338–345CrossRefPubMed

22.

Mustoe TA, Porras-Reyes BH (1993) Modulation of wound healing response in chronic irradiated tissues. Clin Plast Surg 20:465–472PubMed

23.

Kabirian N, Akbarnia BA, Pawelek JB, Alam M, Mundis GM Jr, Acacio R, Thompson GH, Marks DS, Gardner A, Sponseller PD, Skaggs DL, the Growing Spine Study G (2014) Deep surgical site infection following 2344 growing-rod procedures for early-onset scoliosis: risk factors and clinical consequences. J Bone Joint Surg Am 96:e128. doi:10.2106/JBJS.M.00618

24.

Kumar S, van Popta D, Rodrigues-Pinto R, Stephenson J, Mohammad S, Siddique I, Verma RR (2015) Risk factors for wound infection in surgery for spinal metastasis. Eur Spine J 24:528–532. doi:10.1007/s00586-013-3127-4 CrossRefPubMed

Title: Risk factors for surgical site infection after posterior fixation surgery and intraoperative radiotherapy for spinal metastases
Authors: Shurei Sugita
Takahiro Hozumi
Kiyofumi Yamakawa
Takahiro Goto
Taiji Kondo
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 4/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4116-6

ACC 2024 Congress

Springer Medicine

Risk factors for surgical site infection after posterior fixation surgery and intraoperative radiotherapy for spinal metastases

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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