Independent Predictors of Major Wound Complications Requiring Revision Surgery Following Lumbar Spine Surgery: A Large Single-Center Cohort Study

Background Perioperative complications after lumbar spine surgery, including surgical site infections and superficial wound problems drive up costs, prolong hospital stay, and worsen outcomes, yet existing studies of their risk factors are often limited by small sample sizes and weak clinical validation. Although several patient-related risk factors have been identified, many existing studies are limited by small sample sizes or insufficient clinical validation of postoperative wound complications. Objective To identify independent patient- and procedure-related risk factors for major wound complications requiring operative revision after lumbar spine surgery. Study Design Retrospective observational cohort study. Methods Patients undergoing lumbar decompression or instrumented fusion between 2017 and 2023 were retrospectively analyzed. Data on demographics, comorbidities (Charlson Comorbidity Index), American Society of Anesthesiologists classification, preoperative laboratory values, operative duration, blood loss, type of surgery, and intraoperative events were extracted. Group comparisons were performed using appropriate statistical tests. Variables with P < 0.05 were included in a multivariate logistic regression model. Missing data were handled by multiple imputation by chained equations. Odds ratios with 95% confidence intervals were calculated. Results A total of 4067 patients were included, of whom 121 (3.0%) developed major wound complications requiring revision surgery. Infection was confirmed in 75.2% of cases, with a mean time to revision of 24.6 ± 13.3 days. Independent predictors included higher body mass index (OR 1.07 per kg/m², 95% CI 1.04–1.11, P < 0.001), elevated C-reactive protein (OR 1.01 per mg/L, 95% CI 1.00–1.03, P = 0.007), diabetes (OR 1.94, 95% CI 1.27–2.98, P = 0.002), congestive heart failure (OR 4.56, 95% CI 1.42–14.63, P = 0.011), prior lumbar surgery (OR 1.96, 95% CI 1.31–2.94, P < 0.001), dural tear (OR 1.87, 95% CI 1.17–2.98, P = 0.009), and blood loss (per 100 mL, OR 1.11, 95% CI 1.01–1.21, P = 0.027). Conclusion Major wound complications are associated with comorbidities, inflammatory status, prior surgery, dural tears, and blood loss. Clinical Relevance Preoperative recognition of the seven identified risk factors allows surgeons to stratify individual wound-complication risk, optimize modifiable comorbidities, and target perioperative prevention toward the highest-risk patients undergoing lumbar spine surgery. Level of Evidence 3 .