title: Factors influencing wound healing after surgery for metastatic disease of the spine.
abstract: METHODS
  The study group consisted of 53 patients who underwent 75 operations for spine metastases. Patient and tumor demographic factors, preoperative nutritional status, and perioperative adjunctive therapy were retrospectively reviewed.
  
  
  OBJECTIVE
  To determine the risk factors for wound breakdown and infection in patients undergoing surgery for spinal metastases.
  
  
  BACKGROUND
  Spinal fusion using spine implants may be associated with an infection rate of 5% or more. Surgery for spine metastases is associated with an infection rate of 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 patient; tumor type and site; and surgical details were noted. Adjunctive treatment with corticosteroids and radiotherapy was recorded. Nutritional status was evaluated by determining serum protein and serum albumin concentrations and by total lymphocyte count.
  
  
  RESULTS
  Wound breakdown and infection occurred in 15 of 75 wounds. No patient or tumor demographic factors other than intraoperative blood loss (P < 0.1) were statistically associated with infection. The correlation between preoperative protein deficiency (P < 0.01) or perioperative corticosteroid administration (P < 0.10) and wound infection was significant. There was no statistical correlation between lymphocyte count or perioperative radiotherapy and wound infection.
  
  
  CONCLUSIONS
  The results indicate that preoperative protein depletion and perioperative administration of corticosteroids are risk factors for wound infection in patients undergoing surgery for spine metastases. Perioperative correction of nutritional depletion and cessation of steroid therapy may reduce wound complications.
authors.affiliation: Division of Orthopaedic Surgery, University of Queensland, Brisbane, Australia.
authors.forename: I B
authors.initials: IB
authors.lastname: McPhee
authors.forename: R P
authors.initials: RP
authors.lastname: Williams
authors.forename: C E
authors.initials: CE
authors.lastname: Swanson
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D001798:Blood Proteins / Q000032:analysis; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology; D014945:Wound Healing / Q000502:physiology*
chemical_list: D000305:Adrenal Cortex Hormones; D001798:Blood Proteins; D012709:Serum Albumin