Spinal gunshot wounds: A retrospective, multicenter, cohort study. / [Artículo traducido] Lesiones vertebrales por proyectil de arma de fuego: estudio de cohorte retrospectivo, multicéntrico.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Spinal gunshot wounds: A retrospective, multicenter, cohort study.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Wound-related complications in the surgical treatment of vertebral metastatic disease – A case series analysis / Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos

Introduction and objectives: Spinal metastases (SM) account for 5–30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. Materials and methods: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC – surgical site infection, hematoma, and/or dehiscence – at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. Results: 198 patients (121 males and 77 females) with an average age of 65 years (range 54–73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37–45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14–39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02–5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). Conclusions: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.(AU)

Introducción y objetivos: Las metástasis espinales (MV) pueden ocurrir en el 5-30% de los pacientes con cáncer, provocando dolor, deformidad y/o déficit neurológico. Las complicaciones postoperatorias son un motivo de preocupación y las complicaciones relacionadas con la herida (CRH) pueden retrasar el inicio del tratamiento adyuvante. El objetivo de este estudio fue analizar la incidencia de CRH en pacientes con MV sometidos a tratamiento quirúrgico y evaluar los posibles factores de riesgo relacionados con estas complicaciones. Materiales y métodos: Se analizaron pacientes operados por MV entre 2011 y 2021. Se analizaron características demográficas, tumor primario, estado general y neurológico, score de Tokuhashi, tipo de tratamiento quirúrgico, duración de la cirugía, albúmina sérica y hemoglobina preoperatorias, tratamiento adyuvante pre- y postoperatorio. Se evaluó la incidencia y los factores de riesgo de la CRH (infección del sitio quirúrgico, hematoma y/o dehiscencia) a los 90 días. Los pacientes se clasificaron en dos grupos según la ausencia/presencia de CRH. Resultados: Se analizaron 198 pacientes (121 hombres y 77 mujeres) con una edad promedio de 65 años (rango 54-73 años). Se observaron CRH en 44 pacientes (22%). En el análisis multivariado, los predictores significativos para el desarrollo de CRH fueron un score de Tokuhashi bajo (OR=7,89; IC del 95%=1,37-45,35; p=0,021), cáncer de próstata como tumor primario (OR=6,73; IC del 95%=1,14-39,65; p=0,035) y albúmina sérica preoperatoria≤3,5g/dL (OR=2.31; IC del 95%=1,02-5,22; p=0,044). No hubo diferencias entre los grupos en la supervivencia a los 90 días (p=0,714). Conclusiones: En nuestra serie, la incidencia de CRH fue del 22%, los principales factores de riesgo para su aparición fueron el score de Tokuhashi bajo, la albúmina sérica preoperatoria más baja y el cáncer de próstata. Finalmente, la tasa de supervivencia a corto plazo no se vio afectada por la ocurrencia de CRH.(AU)

[Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos / Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis

Introduction and objectives: Spinal metastases (SM) account for 5–30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. Materials and methods: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC – surgical site infection, hematoma, and/or dehiscence – at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. Results: 198 patients (121 males and 77 females) with an average age of 65 years (range 54–73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37–45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14–39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02–5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). Conclusions: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.(AU)

Introducción y objetivos: Las metástasis espinales (MV) pueden ocurrir en el 5-30% de los pacientes con cáncer, provocando dolor, deformidad y/o déficit neurológico. Las complicaciones postoperatorias son un motivo de preocupación y las complicaciones relacionadas con la herida (CRH) pueden retrasar el inicio del tratamiento adyuvante. El objetivo de este estudio fue analizar la incidencia de CRH en pacientes con MV sometidos a tratamiento quirúrgico y evaluar los posibles factores de riesgo relacionados con estas complicaciones. Materiales y métodos: Se analizaron pacientes operados por MV entre 2011 y 2021. Se analizaron características demográficas, tumor primario, estado general y neurológico, score de Tokuhashi, tipo de tratamiento quirúrgico, duración de la cirugía, albúmina sérica y hemoglobina preoperatorias, tratamiento adyuvante pre- y postoperatorio. Se evaluó la incidencia y los factores de riesgo de la CRH (infección del sitio quirúrgico, hematoma y/o dehiscencia) a los 90 días. Los pacientes se clasificaron en dos grupos según la ausencia/presencia de CRH. Resultados: Se analizaron 198 pacientes (121 hombres y 77 mujeres) con una edad promedio de 65 años (rango 54-73 años). Se observaron CRH en 44 pacientes (22%). En el análisis multivariado, los predictores significativos para el desarrollo de CRH fueron un score de Tokuhashi bajo (OR=7,89; IC del 95%=1,37-45,35; p=0,021), cáncer de próstata como tumor primario (OR=6,73; IC del 95%=1,14-39,65; p=0,035) y albúmina sérica preoperatoria≤3,5g/dL (OR=2.31; IC del 95%=1,02-5,22; p=0,044). No hubo diferencias entre los grupos en la supervivencia a los 90 días (p=0,714). Conclusiones: En nuestra serie, la incidencia de CRH fue del 22%, los principales factores de riesgo para su aparición fueron el score de Tokuhashi bajo, la albúmina sérica preoperatoria más baja y el cáncer de próstata. Finalmente, la tasa de supervivencia a corto plazo no se vio afectada por la ocurrencia de CRH.(AU)

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis. / [Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC -surgical site infection, hematoma, and/or dehiscence- at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=.044). There was no difference between groups on 90 days survival rate (p=.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC - surgical site infection, hematoma, and/or dehiscence - at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.