Leary Owen P, Liu David D, Boyajian Michael K, Syed Sohail, Camara-Quintana Joaquin Q, Niu Tianyi, Svokos Konstantina A, Crozier Joseph, Oyelese Adetokunbo A, Liu Paul Y, Woo Albert S, Gokaslan Ziya L, Fridley Jared S
Departments of1Neurosurgery and.
3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island.
J Neurosurg Spine. 2020 Feb 28;33(1):77-86. doi: 10.3171/2019.12.SPINE191238. Print 2020 Jul 1.
Wound breakdown and infection are common postoperative complications following resection of spinal neoplasms. Accordingly, it has become common practice at some centers for plastic surgeons to assist with closure of large posterior defects after spine tumor resection. In this study, the authors tested the hypothesis that plastic surgery closure of complex spinal defects improves wound outcomes following resection of spinal neoplastic disease.
Electronic medical records of consecutive patients who underwent resection of a spinal neoplasm between June 2015 and January 2019 were retrospectively reviewed. Patients were separated into two subpopulations based on whether the surgical wound was closed by plastic surgery or neurosurgery. Patient demographics, preoperative risk factors, surgical details, and postoperative outcomes were collected in a central database and summarized using descriptive statistics. Outcomes of interest included rates of wound complication, reoperation, and mortality. Known preoperative risk factors for wound complication in spinal oncology were identified based on literature review and grouped categorically. The presence of each category of risk factors was then compared between groups. Univariate and multivariate linear regressions were applied to define associations between individual risk factors and wound complications.
One hundred six patients met inclusion criteria, including 60 wounds primarily closed by plastic surgery and 46 by neurosurgery. The plastic surgery population included more patients with systemic metastases (58% vs 37%, p = 0.029), prior radiation (53% vs 17%, p < 0.001), prior chemotherapy (37% vs 15%, p = 0.014), and sacral region tumors (25% vs 7%, p = 0.012), and more patients who underwent procedures requiring larger incisions (7.2 ± 3.6 vs 4.5 ± 2.6 levels, p < 0.001), prolonged operative time (413 ± 161 vs 301 ± 181 minutes, p = 0.001), and greater blood loss (906 ± 1106 vs 283 ± 373 ml, p < 0.001). The average number of risk factor categories present was significantly greater in the plastic surgery group (2.57 vs 1.74, p < 0.001). Despite the higher relative risk, the plastic surgery group did not experience a significantly higher rate of wound complication (28% vs 17%, p = 0.145), reoperation (17% vs 9%, p = 0.234), or all-cause mortality (30% vs 13%, p = 0.076). One patient died from wound-related complications in each group (p = 0.851). Regression analyses identified diabetes, multilevel instrumentation, and BMI as the factors associated with the greatest wound complications.
Involving plastic surgery in the closure of spinal wounds after resection of neoplasms may ameliorate expected increases in wound complications among higher-risk patients.
伤口裂开和感染是脊柱肿瘤切除术后常见的术后并发症。因此，在一些中心，整形外科医生协助闭合脊柱肿瘤切除术后的大型后方缺损已成为常见做法。在本研究中，作者检验了以下假设：对于复杂脊柱缺损，整形外科闭合术可改善脊柱肿瘤性疾病切除术后的伤口预后。
回顾性分析2015年6月至2019年1月期间连续接受脊柱肿瘤切除术患者的电子病历。根据手术伤口是由整形外科还是神经外科闭合，将患者分为两个亚组。患者人口统计学资料、术前危险因素、手术细节和术后结果收集于一个中央数据库，并采用描述性统计进行总结。感兴趣的结果包括伤口并发症发生率、再次手术率和死亡率。基于文献综述确定脊柱肿瘤学中已知的术前伤口并发症危险因素，并进行分类分组。然后比较两组中各类危险因素的存在情况。应用单变量和多变量线性回归来确定个体危险因素与伤口并发症之间的关联。
106例患者符合纳入标准，其中60个伤口主要由整形外科闭合，46个由神经外科闭合。整形外科组中全身转移患者更多（58%对37%，p = 0.029）、曾接受放疗患者更多（53%对17%，p < 0.001）、曾接受化疗患者更多（37%对15%，p = 0.014）、骶骨区域肿瘤患者更多（25%对7%，p = 0.012），并且接受需要更大切口手术的患者更多（7.2±3.6节段对4.5±2.6节段，p < 0.001）、手术时间更长（413±161分钟对301±181分钟，p = 0.001）、失血量更大（906±1106毫升对283±373毫升，p < 0.001）。整形外科组中存在的危险因素类别平均数量显著更多（2.57对1.74，p < 0.001）。尽管相对风险较高，但整形外科组的伤口并发症发生率（28%对17%，p = 0.145）、再次手术率（17%对9%，p = 0.234）或全因死亡率（30%对13%，p = 0.076）并未显著更高。每组各有1例患者死于伤口相关并发症（p = 0.851）。回归分析确定糖尿病、多节段内固定和体重指数是与最大伤口并发症相关的因素。
肿瘤切除术后脊柱伤口闭合时引入整形外科可能改善高危患者中预期增加的伤口并发症。
