I just came off of jury duty where the case involved a man who had spine surgery. He developed an infection from the operation. The key point of the case was that the patient was at too great a risk to have this surgery. Does this happen very often or was this a rare situation?

With improved surgical tools and advanced imaging techniques, more and more surgeries of all kinds are being done these days. The number of spinal operations performed in the United States has really increased over the last 20 years.

There are risks and complications with any surgery. Many studies in the recent past have focused on identifying those risks. Predicting which patients will have a good outcome is a key part of risk assessment.

There are two basic groups of risk factors to review. Patient risk factors include age, obesity, tobacco use, and nutrition. The surgeon will also look at comorbidities. This refers to other health problems the patient may have. Diabetes, incontinence, cancer, and heart disease are some examples of comorbidities.

Operative risk factors are the second group to look at. Anything that increases the operation time or length of stay in the hospital is important. The more complex the operation, the greater the chances for problems to occur. The amount of blood loss can make a difference.

There are other risk factors to consider in the case of spine surgery. How many spinal levels were involved? Did the patient need a bone graft? Did the bone graft come from the patient or a bone bank? Was it necessary to use plates or screws called hardware to stabilize the segment?

Having risk factors doesn't necessarily mean the patient can't have the operation. This information helps surgeons formulate a plan of care. The plan takes these risks into consideration before, during, and after the operation.

Scott W. Zehnder, MD, and Howard M. Place, MD. Vacuum-assisted Wound Closure in Postoperative Spinal Wound Infection. In Orthopedics. April 2007. Vol. 30. No. 4. Pp. 267-272.

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