Related Experiment Video
Updated: Feb 15, 2026
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Surgical site infection in spinal metastasis: incidence and risk factors
Amer Sebaaly1, Daniel Shedid2, Ghassan Boubez3
1Department of Orthopedic Surgery, Spine Unit, Centre Hopitalier de l'Université de Montréal (CHUM), 264 Boulevard René-Lévesque E, Montréal, Quebec H2X 1P1, Canada; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Background:
Surgical site infection (SSI) in spinal metastasis surgery represents the most common postoperative surgical complication with high morbidity and mortality.
Objective:
This study aims to evaluate the incidence of SSI in spinal metastasis surgery and its risk factors.
Study Design:
This is a retrospective analysis of a prospectively collected data.
Methods:
Preoperative, operative, and postoperative data were collected together with the modified Tokuhashi score and Frankel score at all time checkpoints. Surgical site infection was divided into superficial and deep SSI, as well as early (<90 days) and late SSI. Multiple logistic regression analysis was performed to identify independent risk factors, with p<.05 as significance threshold.
Results:
A total of 297 patients were included, with an incidence of SSI of 5.1% (superficial SSI: 3.4%; deep SSI: 1.7 %). Cervicothoracic surgery was associated with the highest incidence of SSI, whereas cervical surgery had the lowest incidence. Smoking, higher number of spinal metastasis, elevated body mass index (BMI), and higher ASA (American Society of Anesthesiologist) score were the preoperative factors associated with increased risk of SSI. Increased intraoperative blood loss and increased number of fixed vertebra increased the SSI incidence. SSI increased hospital stay by a mean of 12 days. When all these variables are analyzed in a multiple regression model, only surgical time≥4 hours and ASA≥3 were found to be independent risk factors for the occurrence of SSI.
Conclusion:
This paper represents the largest series of spinal metastasis with a mean incidence of SSI of 5.1%. Smoking, higher BMI, higher number of spinal metastasis, higher ASA score, higher number of fused vertebra, intraoperative bleeding≥2000 mL, and neurologic deterioration are risk factors for SSI occurrence. Only ASA≥3 and operative duration≥4 hours are independent risk factors for this complication occurrence. Finally, SSI occurrence is associated with increased hospital stay, increased 30-day mortality rate, and decreased survival rates.
Insights
Surgical site infections (SSI) after spinal metastasis surgery occur in 5.1% of patients. High American Society of Anesthesiologist (ASA) score (≥3) and long operative duration (≥4 hours) are independent risk factors for SSI.
Area of Science:
- Spine Surgery
- Oncology
- Infectious Disease
Background:
- Surgical site infection (SSI) is a significant postoperative complication in spinal metastasis surgery.
- High morbidity and mortality rates are associated with SSI in this patient population.
Purpose of the Study:
- To determine the incidence of SSI in spinal metastasis surgery.
- To identify preoperative, operative, and postoperative risk factors associated with SSI.
Main Methods:
- Retrospective analysis of prospectively collected data from 297 patients.
- Collected data included modified Tokuhashi and Frankel scores.
- Multiple logistic regression analysis was used to identify independent risk factors for SSI.
Main Results:
- The overall incidence of SSI was 5.1% (superficial: 3.4%; deep: 1.7%).
- Preoperative factors like smoking, higher BMI, more spinal metastases, and higher ASA score were associated with increased SSI risk.
- Independent risk factors for SSI were identified as surgical time ≥4 hours and ASA score ≥3.
Conclusions:
- This study represents the largest series on spinal metastasis SSI, with a 5.1% incidence.
- Factors such as smoking, BMI, number of spinal metastases, ASA score, blood loss, and operative duration are associated with SSI.
- High ASA score (≥3) and operative duration (≥4 hours) are independent predictors of SSI, which increases hospital stay and mortality.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:24Drug Toxicity: Risk factors
01:08Prevalence and Incidence
Prevalence indicates the proportion of individuals in a population who have a specific disease or health...
02:30Metastasis
Epithelial-to-Mesenchymal Transition
The epithelial-to-mesenchymal transition or EMT is a developmental process commonly observed in wound healing, embryogenesis, and cancer metastasis. EMT is induced by transforming growth factor-beta (TGF-β) or receptor tyrosine kinase (RTK) ligands, which further...
01:12Relative Risk
01:21Types of Reports II: Incident or Occurrence Report
Purposes:
In the healthcare industry, reports play a crucial role in documenting incidents within an agency. The primary objective of these reports is to ensure patient safety, uphold the...