Department of Neurological Surgery, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, New York, New York, USA.
Department of Neurological Surgery, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, New York, New York, USA.
World Neurosurg. 2024 May;185:e351-e356. doi: 10.1016/j.wneu.2024.02.005. Epub 2024 Feb 9.
This was a single-institutional retrospective cohort study.
Wound infections are common following spine metastasis surgery and can result in unplanned reoperations. A recent study published an online wound complication risk calculator but has not yet undergone external validation. Our aim was to evaluate the accuracy of this risk calculator in predicting 30-day wound infections and 30-day wound reoperations using our operative spine metastasis population.
An internal operative database was used to identify patients between 2012 and 2022. The primary outcomes were 1) any surgical site infection and 2) wound-related revision surgery within 30 days following surgery. Patient details were manually collected from electronic medical records and entered into the calculator to determine predicted complication risk percentages. Predicted risks were compared to observed outcomes using receiver operator characteristic (ROC) curves with areas under the curve (AUC).
A total of 153 patients were included. The observed 30-day postoperative wound infection incidence was 5% while the predicted wound infection incidence was 6%. In ROC analysis, good discrimination was found for the wound infection model (AUC = 0.737; P = 0.024). The observed wound reoperation rate was 5% and the predicted wound reoperation rate was 6%. ROC analysis demonstrated poor discrimination for wound reoperations (AUC = 0.559; P = 0.597).
The online wound-related risk calculator was found to accurately predict wound infections but not wound reoperations within our metastatic spine surgery cohort. We suggest that the model may be clinically useful despite underlying population differences, but further work must be done to generate and validate accurate prediction tools.
这是一项单机构回顾性队列研究。
脊柱转移瘤手术后常见伤口感染，可导致计划外再次手术。最近发表的一项研究公布了一种在线伤口并发症风险计算器，但尚未经过外部验证。我们的目的是使用我们的脊柱转移瘤手术人群来评估该风险计算器预测 30 天伤口感染和 30 天伤口再次手术的准确性。
使用内部手术数据库确定 2012 年至 2022 年间的患者。主要结局是 1）任何手术部位感染和 2）手术后 30 天内与伤口相关的修订手术。从电子病历中手动收集患者详细信息并输入计算器，以确定预测并发症风险的百分比。使用接收器操作特征 (ROC) 曲线和曲线下面积 (AUC) 比较预测风险与观察结果。
共纳入 153 例患者。观察到的 30 天术后伤口感染发生率为 5%，而预测的伤口感染发生率为 6%。在 ROC 分析中，伤口感染模型的区分度较好（AUC=0.737；P=0.024）。观察到的伤口再手术率为 5%，预测的伤口再手术率为 6%。ROC 分析显示伤口再手术的区分度较差（AUC=0.559；P=0.597）。
在我们的转移性脊柱手术队列中，在线与伤口相关的风险计算器被发现能够准确预测伤口感染，但不能预测伤口再手术。我们建议，尽管存在人群差异，该模型可能具有临床应用价值，但必须进一步开展工作以生成和验证准确的预测工具。
