30-day sepsis risk after laminectomy for resection of intradural extramedullary (IDEM) tumors based on NSQIP database: a critical appraisal

J Spine Surg 2022 | https://dx.doi.org/10.21037/jss-22-58 The authors need to be appreciated for evaluating the 30-day risk for sepsis following spine surgeries for intradural extramedullary (IDEM) tumor resection. This unique subset of spinal tumors has not been analyzed separately in the published literature for postoperative spinal infections, despite the well-known susceptibility of solid tumor patients to infections. Likewise, this is a discrete heterogenous cohort with varying levels of tissue invasiveness combining both benign and malignant tumors, especially with a wellrecognized complication related to cerebrospinal fluid (CSF) leak which again predisposes to meningitis, sepsis, and septic shock. Mo et al. (1) present a large volume retrospective analysis of 2,027 patients who underwent laminectomy for IDEM tumors, identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. They have highlighted the risk factors that predispose a patient to sepsis, and these include etiologies, such as superficial and deep wound infections, deep vein thrombosis, pulmonary embolism, increased length of stay (>5 days), repeat surgery within 30 days, blood transfusions, higher anesthesia grade, poor preoperative dependent functional status of the patient and longer operating time. The mean time to diagnose sepsis was 14 days, which was consistent with the published data. Of note, the laminectomy per se did not pose additional risk for sepsis and there was no correlation between sepsisrelated complications and mortality. The article showcased that body mass index (BMI) did not have any impact on the development of sepsis which was surprising, considering the linkage between BMI and surgical site infections (SSIs) reported in several other studies (2). However, this finding is consistent with the inference reached in certain other studies where the association of SSI was with the measure of body fat and not with BMI determined obesity (3). Spine Patient Outcomes Research Trial (SPORT) had demonstrated a nonsignificant difference in wound infection rates between the obese and non-obese cohorts undergoing surgical treatment for lumbar disc herniation (4). Smoking has been associated with increased incidence of SSI in literature (5). It was interesting to note that the authors here have shown that chronic obstructive pulmonary disease (COPD), not smoking was significantly correlated with sepsis related complications. Several patients may have stopped smoking prior to the surgery, and hence the duration of abstinence from smoking in the preoperative Editorial