Risk factors for poor wound healing in patients undergoing posterior thoracolumbar tuberculosis surgery: A single-center retrospective observational cohort study

Abstract:

Objective To investigate the risk factors for poor wound healing（PWH） in patients undergoing thoracolumbar tuberculosis surgery.Methods A retrospective analysis was performed for 124 patients who underwent posterior thoracolumbar tuberculosis debridement，bone graft fusion，and internal fixation in Department of Orthopedics，The First Affiliated Hospital of Chongqing Medical University from January 2019 to October 2021，among whom there were 16 patients with PWH and 108 patients without PWH. According to the presence or absence of PWH after surgery，they were divided into PWH group and non-PWH group. The two groups were compared in terms of preoperative data，including sex，age，smoking/drinking history，comorbidity of hypertension/pulmonary tuberculosis/diabetes，number of surgically fixed segments，body mass index，mean corpuscular volume（MCV），mean corpuscular hemoglobin（MCH），mean corpuscular hemoglobin concentration（MCHC），hemoglobin（Hb），platelet count（PLT），neutrophil count and percentage，lymphocyte count and percentage，monocyte count and percentage，prealbumin，albumin，erythrocyte sedimentation rate（ESR），and C-reactive protein（CRP）. The univariate analysis，the multivariate binary logistic regression analysis，and the receiver operating characteristic（ROC） curve analysis were used to investigate related influencing factors.Results The univariate analysis showed that pulmonary tuberculosis（χ²=5.458，P=0.019），number of surgically fixed segments（Z=-3.407，P=0.001），PLT（Z=-2.766，P=0.006），MCV（Z=2.957，P=0.004），MCH（Z=-3.001，P=0.003），MCHC（Z=2.379，P=0.019），absolute neutrophil count（Z=-3.723，P<0.001），percentage of neutrophils（Z=-3.678，P<0.001），lymphocyte percentage（Z=3.798，P<0.001），Hb（Z=-3.225，P=0.001），prealbumin（Z=3.988，P<0.001），albumin（Z=-3.562，P<0.001），ESR（Z=-2.971，P=0.003），and CRP（Z=-4.305，P<0.001） were significant risk factors. The multivariate binary logistic regression analysis showed that the number of surgically fixed segments，preoperative percentage of neutrophils，preoperative absolute neutrophil count，preoperative lymphocyte percentage，and CRP were independent risk factors for postoperative PWH in patients with thoracolumbar tuberculosis. The ROC curve analysis showed that the cut-off values of the number of surgically fixed segments，preoperative percentage of neutrophils，preoperative absolute neutrophil count，preoperative lymphocyte percentage，and CRP were 5 segments，71.5%，5.29×10⁹/L，19.45%，and 40.95 mg/L，respectively.Conclusion Incision length can be shortened to reduce surgical trauma，and preoperative monitoring of neutrophils，lymphocytes，and CRP can reduce the risk of PWH in patients after thoracolumbar tuberculosis surgery.