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Postoperative Surgical Site Infections in Patients Undergoing Spinal Tumor Surgery: Incidence and Risk Factors

Omeis, Ibrahim A., MD; Dhir, Mashaal, MD; Sciubba, Daniel M., MD; Gottfried, Oren N., MD; McGirt, Matthew J., MD; Attenello, Frank J., MD; Wolinsky, Jean-Paul, MD; Gokaslan, Ziya L., MD

doi: 10.1097/BRS.0b013e3181f48fa9

Study Design. We conducted a retrospective, case control study on patients undergoing surgery for spinal tumors.

Objective. Our aim was to determine the incidence and to identify risk factors for surgical site infections (SSIs) in patients undergoing surgery for spinal tumors.

Summary of Background Data. SSIs after spinal tumor surgery may be particularly devastating as they may add to substantial surgical morbidity and may further exacerbate already existing neurologic deficits. Incidence and risk factors predisposing to SSIs in patients undergoing surgery for spinal tumors are not well studied yet.

Methods. Between January 1995 and February 2008, 971 procedures for spinal tumors were performed on 739 patients. Excluding sacral tumors from the current study, 895 procedures on 678 patients were reviewed to identify those cases with SSIs. Furthermore, 65 infected cases and a randomly selected subset of 162 controls were analyzed by logistic regression modeling to identify the risk factors associated with SSIs.

Results. There were 678 patients that were included in this study with 364 men (54%) and 314 women (46%), with an average age of 47.2 year. Sixty-five patients who developed SSIs underwent a total of 162 procedures including 78 procedures for wound debridement and washout. The incidence of SSIs was 8.89% for primary nonbony spinal tumors, 9.5% for metastatic spinal tumors, and 13.7% for primary bony spinal tumors. Staphylococcus aureus was the most commonly isolated organism (n = 22 of 65, 33%). In the multivariate logistic regression model, previous spinal surgeries, complex plastic closures, increasing number of comorbidities, presence of a hospital acquired infection at the time of a previous surgery, and increasing duration of hospital stay during primary surgery were significantly associated with increased likelihood of developing postoperative SSIs.

Conclusion. Surgery for spine tumors appears to be associated with a higher incidence of SSI than nontumor spine surgery. Identification of perioperative risk factors will help delineate this subset of patients with high risk for developing SSIs thus potentially allowing perioperative modification for such factors, which may lead to an overall better clinical outcome and patient satisfaction.

We conducted a retrospective study to determine the incidence and risk factors for surgical site infections on patients undergoing surgery for spinal tumors. Between 1995 and 2008, 678 patients were identified. There were 65 infected cases. Randomly selected 162 controls were analyzed by logistic regression to identify risk factors associated with SSI.

Department of Neurosurgery, John Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Ibrahim Omeis, MD, Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden Rd, 750, Houston, TX 77030; E-mail:

Acknowledgement date: June 23, 2009. First Revision date: March 18, 2010. Second revision date: May 27, 2010. Acceptance date: July 6, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.