Risk Factors for Poor Wound Healing Following Posterior Lumbar Spine Surgery in Patients with Lumbar Degenerative Diseases: A Retrospective Case-Control Study ShortTitle: Risk Factors for Poor Wound Healing

Risk Factors for Poor Wound Healing Following Posterior Lumbar Spine Surgery in Patients with Lumbar Degenerative Diseases: A Retrospective Case-Control Study ShortTitle: Risk Factors for Poor Wound Healing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk Factors for Poor Wound Healing Following Posterior Lumbar Spine Surgery in Patients with Lumbar Degenerative Diseases: A Retrospective Case-Control Study ShortTitle: Risk Factors for Poor Wound Healing Wenqiang Xing, Jingming Wang, Guangran Li, Lei Wang, Yi Liu, Weimin Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7317302/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study aimed to identify the risk factors associated with poor wound healing (PWH) following posterior lumbar spine surgery in patients with lumbar degenerative diseases (LDD). Methods From January 2019 to January 2023, consecutive patients who underwent lumbar spine surgery at our hospital were retrospectively studied. Data on patients' baseline characteristics, clinical information, and imaging findings were collected, and multiple logistic regression analysis was employed to assess the risk factors for PWH. Results A total of 1050 patients were included in the final analysis, of whom 79 exhibited post-operative PWH complications, while 971 demonstrated normal healing. The results of the multiple regression analysis indicated that male sex (OR=2.188, 95% CI=1.304-2.670, p<0.05)and high body mass index (BMI) (OR=1.882, 95% CI 1.147-3.089, p<0.05) were independent risk factors for PWH. Conclusions Male patients and those with a high BMI are at increased risk of experiencing PWH following lumbar spine surgery. These findings underscore the importance of closely monitoring these high-risk patient groups in clinical practice and implementing appropriate preventive measures to enhance postoperative outcomes. Figures Figure 1 Introduction Lumbar degenerative disease represents a prevalent clinical entity in orthopedic practice[ 1 , 2 ]. For cases refractory to conservative management, posterior lumbar surgery emerges as a frequently employed surgical intervention, with the majority of operative techniques demonstrating satisfactory clinical efficacy[ 3 , 4 ]. However, this surgical approach carries an elevated risk of postoperative PWH, attributable to extensive tissue dissection, challenging anatomical accessibility, procedural complexity, prolonged duration of surgical procedures, and implantation of fixation devices[ 5 ]. Clinical manifestations of PWH include fat liquefaction, persistent serous drainage, wound dehiscence, and/or exudate accumulation, which may progress to surgical site infections (SSI)[ 6 , 7 ]. The occurrence of SSI significantly impairs wound healing processes, thereby prolonging postoperative recovery, extending hospital stays, and increasing medical costs[ 8 ]. In severe cases, SSI may lead to internal fixation failure, necessitating further surgical intervention, or even result in permanent neurological dysfunction or sepsis, along with other systemic complications[ 9 ]. PWH is associated with various factors. Established risk factors include diabetes mellitus, advanced age, nutritional deficiencies, and osteoporosis, as demonstrated by prior studies[ 10 – 12 ]. Posterior lumbar spine surgery may present different risk factors for PWH compared to other surgical procedures due to its unique anatomical location, tissue structure, and the use of internal fixation. Despite the prevalence of posterior lumbar surgeries, there is a paucity of studies specifically addressing PWH. Most existing research has concentrated on risk factors related to wound infection following posterior lumbar surgery, however, wound infection and delayed wound healing represent distinct clinical scenarios[ 3 , 13 ]. Currently, there remains a significant gap in research concerning PWH following posterior lumbar spine surgery. This study aims to identify the risk factors associated with delayed incision healing following posterior lumbar spine surgery through a retrospective case-control analysis, with the objective of informing clinical prevention and intervention strategies. Patients and Methods Study Design This retrospective case-control study was designed to identify risk factors for PWH in patients undergoing open posterior lumbar surgery. The study protocol received ethical approval from the institutional review board and was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study population comprised patients who underwent posterior open lumbar surgery at our institution between January 2019 and January 2023. Inclusion and Exclusion Criteria Inclusion Criteria: (1) patients aged 18 years or older; (2) patients diagnosed with LDD who underwent posterior lumbar spine surgery;(3) availability of complete clinical data. Exclusion Criteria: (1) previous lumbar spine surgery (either open or minimally invasive); (2) concurrent immune-mediated disorders; (3) patients with tumors; (4) patients with mental disorders, alcohol dependence, or a history of drug abuse. Data Collection Demographic characteristics, surgical information and imaging features were retrospectively collected. Demographic variables comprised age, sex, BMI, comorbid conditions (hypertension and diabetes mellitus), and lifestyle factors (smoking status and alcohol consumption). Surgical variables included intraoperative blood loss and the presence or absence of PWH. The imaging indicators included the Modic sign and the fat infiltration grade of paraspinal muscles[ 14 ]. Age stratification was performed using a 60-year threshold, creating two groups: ≤60 years and > 60 years. BMI categorization utilized a cutoff value of 28 kg/m², dichotomizing participants into ≥ 28 kg/m² and < 28 kg/m² groups[ 15 ]. All clinical data were systematically retrieved from the electronic medical records and independently verified by two trained authors to ensure data integrity and completeness. Clinical evaluation PWH was defined as[ 16 ]: (a) a prolonged wound healing duration exceeding 14 days; (b) persistent wound exudation lasting more than 3 days; (c) wound dehiscence characterized by edge separation greater than 1 cm in width and 2 cm in length. Statistical analysis Statistical analyses were conducted using SPSS version 22.0 (IBM Corporation, Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD); Whitney U test was employed for non-normally distributed data, while the t-test was applied to normally distributed variables. Categorical data were analyzed using the chi-square test. Both univariate and multivariate logistic regression analyses were performed to identify significant risk factors associated with PWH. P < 0.05 was considered statistically significant. Results Baseline characteristics A total of 1,050 participants were included in the study, with 394 males (37.52%) and 656 females (62.48%). Among these individuals, 971 patients (92.48%) exhibited normal incision healing, while 79 patients (7.52%) demonstrated PWH. Specifically, among the cases of incision complications, there were 41 instances (3.90%) of exudation, 20 instances (1.90%) of delayed healing, and 18 instances (1.71%) of fat liquefaction. The detailed information was exhibited in Table 1 . Table 1 Baseline characteristics of the included patients Variables Normal group n = 971 PWH group n = 79 P value Age 0.226 ≤ 60 years 509 47 >60 years 462 32 Gender 0.006 Male 353 41 Female 618 38 Smokers 0.616 No 808 64 Yes 163 15 Alcohol Consumption 0.308 No 817 63 Yes 154 16 Diabetes 0.194 No 959 66 Yes 112 13 BMI 0.010 50 422 33 PWH , poor wound healing; BMI , body mass index Univariate logistic regression analysis Univariate logistic regression analyses revealed that male (OR = 1.899, 95% CI = 1.192–2.993, p < 0.05) and high BMI (OR = 1.893, 95% CI = 1.160–3.088, p < 0.05) were risk factors for PWH. The detailed information was exhibited in Table 2 . Table 2 Univariate logistic regression analyses of prognostic factors for PWH Variables OR 95%CI P Gender 1.889 1.192 2.993 0.007 Age 0.750 0.470 1.196 0.227 BMI 1.893 1.160 3.088 0.011 Surgical levels 1.144 0.723 1.810 0.565 Smokers 1.162 0.646 2.809 0.616 Diabetes 1.511 0.807 2.827 0.197 BMI , Body mass index; OR , Odds ratio; CI , Confidential index Multivariate logistic regression analysis Multivariate regression analysis demonstrated that male (OR = 2.188, 95% CI = 1.304–2.670, p < 0.05) and high BMI (OR = 1.882, 95% CI = 1.147–3.089, p < 0.05) remained independent predictors of PWH. The detailed information was demonstrated in Table 3 . Table 3 Multivariate logistic regression analyses of prognostic factors for PWH Variables OR 95%CI P Gender 2.188 1.304 2.670 0.003 Age 0.753 0.466 1.217 0.247 BMI 1.882 1.147 3.089 0.012 Surgical levels 1.192 0.745 1.907 0.464 Smokers 0.700 0.361 1.355 0.290 Diabetes 1.601 0.844 3.035 0.150 BMI , Body mass index; OR , Odds ratio; CI , Confidential index Discussion This study utilized a retrospective case-control methodology to thoroughly investigate the risk factors associated with PWH following lumbar spine surgery. The analysis identified elevated BMI and male sex as independent predictors of suboptimal postoperative incision healing. These findings contribute to a deeper understanding of postoperative complications in lumbar surgery and provide clinically relevant insights for prevention and management strategies. In a retrospective cohort study of 400 patients with type 2 diabetes mellitus undergoing posterior fusion for LDD, Huang et al. analyzed baseline data, clinical data, blood glucose levels, and surgery-related information. The study revealed that the average perioperative blood glucose level and its fluctuations significantly correlated with the occurrence of PWH complications following lumbar fusion. Furthermore, that patients with a BMI of ≥ 25 kg/m² demonstrated significantly higher PWH risk. Notably, the prevalence of BMI ≥ 25 kg/m² was 55.7% in the PWH group versus 29.4% in controls (p < 0.001), suggesting that a higher BMI is a contributing risk factor for impaired incision healing[ 17 ]. In their retrospective analysis of elective lumbar degenerative surgery cases, Klemencsic et al. identified age over 54 years and a BMI greater than 28 kg/m² as independent risk factors for SSI. Among the 723 eligible patients included in the study, 25 developed spinal SSI. The authors suggest that patients with a higher BMI possess larger amounts of subcutaneous adipose tissue, which necessitates greater retraction force during surgery. This thicker layer of fat tissue consequently increases the surface area of necrotic tissue. Diminished tissue perfusion and necrosis impair optimal neutrophil function, facilitating the colonization of bacterial pathogens in the wound and leading to the development of SSI[ 18 ]. High BMI is an independent risk factor for PWH, which may be closely associated with the physiological characteristics of obese individuals[ 19 ]. These patients typically possess a thick subcutaneous fat layer, and fat liquefaction can occur during surgery, complicating the procedure and potentially impairing the normal healing process of the incision[ 20 ]. Furthermore, the frequent presence of metabolic comorbidities (including diabetes mellitus and hyperlipidemia) in obese patients may impair nutritional status and immune competence, thereby exacerbating wound healing impairment[ 21 ]. Consequently, for patients with a high BMI, it is essential to conduct a comprehensive preoperative assessment, optimize the surgical plan, and enhance postoperative care and nutritional support to mitigate the incidence of PWH. Male gender, as an independent risk factor for PWH, potentially mediated by gender-specific differences in skin architecture and physiological characteristics. Compared to females, male patients typically exhibit thicker skin and reduced vascularity, potentially compromising blood perfusion and nutrient delivery to the wound site, thereby predisposing to impaired healing[ 22 ]. Research by Sang et al. supports our view. They retrospectively analyzed 3,080 patients who underwent PLIF surgery and found that male was one of the risk factors for SSI[ 23 ]. Experimental studies have established the inhibitory role of androgens in cutaneous wound healing, manifesting as delayed healing in male murine models. Notably, this inhibitory effect is reversible through exogenous androgen administration in castrated murine models[ 24 ]. Furthermore, the role of the androgen receptor (AR) in skin cells has garnered significant attention. Current evidence suggests AR plays a pivotal role in regulating cutaneous wound healing processes. Targeted AR knockout models demonstrate profound effects on wound healing dynamics, including impaired epidermal migration, suppressed re-epithelialization, enhanced apoptosis, and reduced epithelial proliferation and collagen synthesis[ 25 ]. Male subjects exhibit more intense and sustained infiltration of neutrophils and macrophages at wound sites[ 26 ]. Experimental studies demonstrate significantly elevated macrophage counts and pro-inflammatory cytokine levels (particularly TNF-α) in male murine wound models compared to female counterparts. This discrepancy may contribute to an exaggerated and extended inflammatory response during the wound healing process. In terms of cytokine secretion, females typically produce greater amounts of anti-inflammatory cytokines, such as IL-10, which aid in mitigating inflammatory responses and promoting wound healing. Conversely, male subjects exhibit elevated secretion of pro-inflammatory mediators (including TNF-α and IL-1β), which may contribute to delayed wound healing.[ 27 ]. Several limitations should be acknowledged in this study. First, the retrospective nature of data collection from medical records may introduce information bias and data incompleteness. Second, the single-center design and patient selection from a single institution may limit the generalizability of our findings. This relatively homogeneous sample source may introduce selection bias, thereby limiting the generalizability of the study results. Furthermore, despite the multifactorial nature of PWH following lumbar surgery, our analysis was limited to baseline characteristics, clinical parameters, and imaging features. Future research should aim to expand the sample size, enhance the research design, and explore the risk factors for poor postoperative incision healing from lumbar spine surgery from multiple dimensions, thereby providing a more comprehensive and clinically accurate reference. Declarations I declare that the authors have no competing interests, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Ethics approval and consent to participate The study protocol received ethical approval from the institutional review board of 960 Hospital (960H2022070). Due to the retrospective nature of this study, the requirement for informed consent was waived by the reviewing board, as all patient data were de-identified and analyzed in a manner that ensures confidentiality, adhering to the ethical principles outlined in the Declaration of Helsinki. Consent for Publication Not applicable. Competing interests I declare that the authors have no competing interests, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Availability of Data and Materials The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request. Clinical Trial Number Clinical trial number is not applicable. Funding This study was funded by Shandong Provincial Medical and Health Development Plan (No. 202404071129). This study was supported by the fund from the Science and Technology Innovation Team of 960 Hospital. Authors' contributions All authors contributed to the manuscript. Study conception and design: WH; acquisition and analysis of data: WX, GL, JW; methodology: WX, YL, WH; funding acquisition: LW; writing—original draft: WX, YL; writing—review and editing: YL, WH. Acknowledgements Not applicable References Ravindra VM, Senglaub SS, Rattani A, Dewan MC, Härtl R, Bisson E, Park KB, Shrime MG. Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume. Global Spine J. 2018;8(8):784–94. Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. Spine. 2019;44(5):369–76. Debono B, Wainwright TW, Wang MCY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Huec JCL, Fawcett WJ, Ljungqvist O, et al. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J. 2021;21(5):729–52. Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T, Rekeland F, Franssen E, Weber C, Brisby H, et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. N Engl J Med. 2021;385(6):526–38. Wang SK, Wang P, Li XY, Sun WZ, Kong C, Lu SB. Enhanced recovery after surgery pathway: association with lower incidence of wound complications and severe hypoalbuminemia in patients undergoing posterior lumbar fusion surgery. J Orthop Surg Res. 2022;17(1):8. Hom DB, Davis ME. Reducing Risks for Poor Surgical Wound Healing. Facial Plast Surg Clin North Am. 2023;31(2):171–81. Smart H, AiGhareeb AM, Smart SA. 25-Hydroxyvitamin D Deficiency: Impacting Deep-Wound Infection and Poor Healing Outcomes in Patients With Diabetes. Adv Skin Wound Care. 2019;32(7):321–8. Seidelman JL, Mantyh CR, Anderson DJ. Surgical Site Infection Prevention A Review. JAMA-J Am Med Assoc. 2023;329(3):244–52. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96(1):1–15. Eming SA, Martin P, Tomic-Canic M. Wound repair and regeneration: Mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):16. Li J, Jia G, Dong W, Zhao F, Zhao Z, Yu X, Zhu C, Li J, Liu S, Jiang X, et al. Incidence and risk factors of delayed wound healing in patients who underwent unicompartmental knee arthroplasty. Int Wound J. 2023;20(2):508–15. Zhong C, Lu W, Xie W, Jiao W. A prediction model of risk factors of poor wound healing after craniocerebral surgery. Pakistan J Med Sci. 2023;39(6):1835–9. Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM, Errico TJ, Kim HJ, et al. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg-Spine. 2016;25(1):1–14. Jensen TS, Karppinen J, Sorensen JS, Niinimäki J, Leboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17(11):1407–22. Ezzati M, Bentham J, Di Cesare M, Bilano V, Bixby H, Zhou B, Stevens GA, Riley LM, Taddei C, Hajifathalian K, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42. Jiang G, Zhu Y, Zhang M, Qin W, Xiong T, Ou Y. The risk factors of the postoperative poor wound healing in spinal tuberculosis patients: A single centre retrospective cohort study. Int Wound J. 2022;19(7):1669–76. Chen H, Wu Z, Chen D, Huang F. Correlation between blood glucose level and poor wound healing after posterior lumbar interbody fusion in patients with type 2 diabetes. Int Wound J. 2024;21(1):e14340. Klemencsics I, Lazary A, Szoverfi Z, Bozsodi A, Eltes P, Varga PP. Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Spine J. 2016;16(11):1377–83. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: Skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007;56(6):901–16. Wilson JA, Clark JJ. Obesity: impediment to postsurgical wound healing. Adv Skin Wound Care. 2004;17(8):426–35. Sullivan PW, Ghushchyan VH, Ben-Joseph R. The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States. Qual Life Res. 2008;17(8):1063–71. Keaney TC. Aging in the Male Face: Intrinsic and Extrinsic Factors. Dermatol Surg. 2016;42(7):797–803. Sang C, Chen X, Ren H, Meng Z, Jiang J, Qin Y. Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case-control study. BMC Surg. 2020;20(1):35. Shi H, Cheer K, Simanainen U, Lesmana B, Ma D, Hew JJ, Parungao RJ, Li Z, Cooper MS, Handelsman DJ, et al. The contradictory role of androgens in cutaneous and major burn wound healing. Burns Trauma. 2021;9:tkaa046. Chua ME, Rong M, Tuba-Ang K, Silangcruz JMA, Tanseco PP, Ming JMC, Kim KH, Hui CC, Farhat WA. The impact of sex hormones on genital wound healing in mice: a comparative study. J Pediatr Urol. 2019;15(6):635–41. Wee WKJ, Low ZS, Ooi CK, Henategala BP, Lim ZGR, Yip YS, Vos MIG, Tan WWR, Cheng HS, Tan NS. Single-cell analysis of skin immune cells reveals an Angptl4-ifi20b axis that regulates monocyte differentiation during wound healing. Cell Death Dis. 2022;13(2):180. Gawronska-Kozak B, Kopcewicz M, Machcinska-Zielinska S, Walendzik K, Wisniewska J, Drukała J, Wasniewski T, Rutkowska J, Malinowski P, Pulinski M. Gender Differences in Post-Operative Human Skin. Biomedicines 2023, 11(10). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7317302","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504828473,"identity":"e787f2c1-5ec5-4145-bca1-c5c4fbd93be2","order_by":0,"name":"Wenqiang Xing","email":"","orcid":"","institution":"960th Hospital of PLA","correspondingAuthor":false,"prefix":"","firstName":"Wenqiang","middleName":"","lastName":"Xing","suffix":""},{"id":504828474,"identity":"35dfb8a3-82a0-4f99-97e7-a3750ac87650","order_by":1,"name":"Jingming Wang","email":"","orcid":"","institution":"960th Hospital of PLA","correspondingAuthor":false,"prefix":"","firstName":"Jingming","middleName":"","lastName":"Wang","suffix":""},{"id":504828476,"identity":"cca314d2-b8b7-49a7-bcdd-9b9e9ec95ab7","order_by":2,"name":"Guangran Li","email":"","orcid":"","institution":"960th Hospital of PLA","correspondingAuthor":false,"prefix":"","firstName":"Guangran","middleName":"","lastName":"Li","suffix":""},{"id":504828478,"identity":"7f93fef0-063c-4c2d-8dda-829366008ea9","order_by":3,"name":"Lei Wang","email":"","orcid":"","institution":"960th Hospital of PLA","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Wang","suffix":""},{"id":504828484,"identity":"b469ab14-68a7-4fe2-8580-7eb1de6466d2","order_by":4,"name":"Yi Liu","email":"","orcid":"","institution":"Jinan First Retirement Cadre Sanatorium","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Liu","suffix":""},{"id":504828486,"identity":"770d7f17-c16f-4f9a-8ab2-a98ab644dac5","order_by":5,"name":"Weimin Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYNCCiho5Nvb2A6RoOXPMmI/nTAIJOhjbmBPnSTgYEKeaXyL52AcGNrb0NgmGBIYfFdsIa5GckZY8g4FHJrdNuvEAY8+Z24S1GJw5Y8zAIMGW2yZzIIGZsY0ILfZnzn8GamROZ5NIMCBOiwF7DzMDQwJzAvFaJI63AR124JhhGzCQDxLlF/5m5scMjP9q5OXb2w8++FFBhBYQYP4DZRwgTv0oGAWjYBSMAoIAAGLvNMWOjZ4RAAAAAElFTkSuQmCC","orcid":"","institution":"960th Hospital of PLA","correspondingAuthor":true,"prefix":"","firstName":"Weimin","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2025-08-07 09:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7317302/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7317302/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89979597,"identity":"7f964c78-60d7-4ce9-91f9-e35ebb741006","added_by":"auto","created_at":"2025-08-27 06:18:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31395,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figture.png","url":"https://assets-eu.researchsquare.com/files/rs-7317302/v1/9d6b2a1c27abbbef5337c875.png"},{"id":91298155,"identity":"1f53f62e-c393-40c6-b39e-2908e15eee15","added_by":"auto","created_at":"2025-09-15 04:01:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":728110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7317302/v1/7726c31b-61be-44ab-87af-934d2aa39af1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk Factors for Poor Wound Healing Following Posterior Lumbar Spine Surgery in Patients with Lumbar Degenerative Diseases: A Retrospective Case-Control Study ShortTitle: Risk Factors for Poor Wound Healing","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLumbar degenerative disease represents a prevalent clinical entity in orthopedic practice[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For cases refractory to conservative management, posterior lumbar surgery emerges as a frequently employed surgical intervention, with the majority of operative techniques demonstrating satisfactory clinical efficacy[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, this surgical approach carries an elevated risk of postoperative PWH, attributable to extensive tissue dissection, challenging anatomical accessibility, procedural complexity, prolonged duration of surgical procedures, and implantation of fixation devices[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Clinical manifestations of PWH include fat liquefaction, persistent serous drainage, wound dehiscence, and/or exudate accumulation, which may progress to surgical site infections (SSI)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The occurrence of SSI significantly impairs wound healing processes, thereby prolonging postoperative recovery, extending hospital stays, and increasing medical costs[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In severe cases, SSI may lead to internal fixation failure, necessitating further surgical intervention, or even result in permanent neurological dysfunction or sepsis, along with other systemic complications[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePWH is associated with various factors. Established risk factors include diabetes mellitus, advanced age, nutritional deficiencies, and osteoporosis, as demonstrated by prior studies[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Posterior lumbar spine surgery may present different risk factors for PWH compared to other surgical procedures due to its unique anatomical location, tissue structure, and the use of internal fixation. Despite the prevalence of posterior lumbar surgeries, there is a paucity of studies specifically addressing PWH. Most existing research has concentrated on risk factors related to wound infection following posterior lumbar surgery, however, wound infection and delayed wound healing represent distinct clinical scenarios[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Currently, there remains a significant gap in research concerning PWH following posterior lumbar spine surgery.\u003c/p\u003e\u003cp\u003eThis study aims to identify the risk factors associated with delayed incision healing following posterior lumbar spine surgery through a retrospective case-control analysis, with the objective of informing clinical prevention and intervention strategies.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eThis retrospective case-control study was designed to identify risk factors for PWH in patients undergoing open posterior lumbar surgery. The study protocol received ethical approval from the institutional review board and was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study population comprised patients who underwent posterior open lumbar surgery at our institution between January 2019 and January 2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion Criteria: (1) patients aged 18 years or older; (2) patients diagnosed with LDD who underwent posterior lumbar spine surgery;(3) availability of complete clinical data.\u003c/p\u003e\n\u003cp\u003eExclusion Criteria: (1) previous lumbar spine surgery (either open or minimally invasive); (2) concurrent immune-mediated disorders; (3) patients with tumors; (4) patients with mental disorders, alcohol dependence, or a history of drug abuse.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eDemographic characteristics, surgical information and imaging features were retrospectively collected. Demographic variables comprised age, sex, BMI, comorbid conditions (hypertension and diabetes mellitus), and lifestyle factors (smoking status and alcohol consumption). Surgical variables included intraoperative blood loss and the presence or absence of PWH. The imaging indicators included the Modic sign and the fat infiltration grade of paraspinal muscles[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAge stratification was performed using a 60-year threshold, creating two groups: \u0026le;60 years and \u0026gt;\u0026thinsp;60 years. BMI categorization utilized a cutoff value of 28 kg/m\u0026sup2;, dichotomizing participants into \u0026ge;\u0026thinsp;28 kg/m\u0026sup2; and \u0026lt;\u0026thinsp;28 kg/m\u0026sup2; groups[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAll clinical data were systematically retrieved from the electronic medical records and independently verified by two trained authors to ensure data integrity and completeness.\u003c/p\u003e\n\u003ch3\u003eClinical evaluation\u003c/h3\u003e\n\u003cp\u003ePWH was defined as[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]: (a) a prolonged wound healing duration exceeding 14 days; (b) persistent wound exudation lasting more than 3 days; (c) wound dehiscence characterized by edge separation greater than 1 cm in width and 2 cm in length.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eStatistical analyses were conducted using SPSS version 22.0 (IBM Corporation, Armonk, NY, USA). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD); Whitney U test was employed for non-normally distributed data, while the t-test was applied to normally distributed variables. Categorical data were analyzed using the chi-square test. Both univariate and multivariate logistic regression analyses were performed to identify significant risk factors associated with PWH. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eBaseline characteristics\u003c/h2\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003cp\u003eA total of 1,050 participants were included in the study, with 394 males (37.52%) and 656 females (62.48%). Among these individuals, 971 patients (92.48%) exhibited normal incision healing, while 79 patients (7.52%) demonstrated PWH. Specifically, among the cases of incision complications, there were 41 instances (3.90%) of exudation, 20 instances (1.90%) of delayed healing, and 18 instances (1.71%) of fat liquefaction. The detailed information was exhibited in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eBaseline characteristics of the included patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal group\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;971\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePWH group\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;79\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.226\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;60 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e509\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;60 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e462\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e353\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e618\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSmokers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.616\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e808\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlcohol Consumption\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.308\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e154\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.194\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e959\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e112\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e762\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e209\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOperative levels\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.565\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOne level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e512\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwo or multiple\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e459\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFatty infiltration of multifidus muscle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.260\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;50%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e541\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e422\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e\u003cem\u003ePWH\u003c/em\u003e, poor wound healing; \u003cem\u003eBMI\u003c/em\u003e, body mass index\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eUnivariate logistic regression analysis\u003c/h3\u003e\n\u003cp\u003eUnivariate logistic regression analyses revealed that male (OR\u0026thinsp;=\u0026thinsp;1.899, 95% CI\u0026thinsp;=\u0026thinsp;1.192\u0026ndash;2.993, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and high BMI (OR\u0026thinsp;=\u0026thinsp;1.893, 95% CI\u0026thinsp;=\u0026thinsp;1.160\u0026ndash;3.088, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were risk factors for PWH. The detailed information was exhibited in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eUnivariate logistic regression analyses of prognostic factors for PWH\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.889\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.993\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.750\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.470\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.196\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.227\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.893\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.160\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.088\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eSurgical levels\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.144\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.723\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.810\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.565\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eSmokers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.162\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.646\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.809\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.616\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.511\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.807\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.827\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.197\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr style=\"height: 13px;\"\u003e\n\u003ctd style=\"height: 13px;\" colspan=\"5\"\u003e\u003cem\u003eBMI\u003c/em\u003e, Body mass index; \u003cem\u003eOR\u003c/em\u003e, Odds ratio; \u003cem\u003eCI\u003c/em\u003e, Confidential index\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eMultivariate logistic regression analysis\u003c/h3\u003e\n\u003cp\u003eMultivariate regression analysis demonstrated that male (OR\u0026thinsp;=\u0026thinsp;2.188, 95% CI\u0026thinsp;=\u0026thinsp;1.304\u0026ndash;2.670, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and high BMI (OR\u0026thinsp;=\u0026thinsp;1.882, 95% CI\u0026thinsp;=\u0026thinsp;1.147\u0026ndash;3.089, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) remained independent predictors of PWH. The detailed information was demonstrated in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultivariate logistic regression analyses of prognostic factors for PWH\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.188\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.304\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.670\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.753\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.466\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.217\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.247\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.882\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.089\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSurgical levels\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.745\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.907\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.464\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSmokers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.700\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.361\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.355\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.290\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.601\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.844\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.035\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cem\u003eBMI\u003c/em\u003e, Body mass index; \u003cem\u003eOR\u003c/em\u003e, Odds ratio; \u003cem\u003eCI\u003c/em\u003e, Confidential index\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study utilized a retrospective case-control methodology to thoroughly investigate the risk factors associated with PWH following lumbar spine surgery. The analysis identified elevated BMI and male sex as independent predictors of suboptimal postoperative incision healing. These findings contribute to a deeper understanding of postoperative complications in lumbar surgery and provide clinically relevant insights for prevention and management strategies.\u003c/p\u003e\u003cp\u003eIn a retrospective cohort study of 400 patients with type 2 diabetes mellitus undergoing posterior fusion for LDD, Huang et al. analyzed baseline data, clinical data, blood glucose levels, and surgery-related information. The study revealed that the average perioperative blood glucose level and its fluctuations significantly correlated with the occurrence of PWH complications following lumbar fusion. Furthermore, that patients with a BMI of \u0026ge;\u0026thinsp;25 kg/m\u0026sup2; demonstrated significantly higher PWH risk. Notably, the prevalence of BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2; was 55.7% in the PWH group versus 29.4% in controls (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that a higher BMI is a contributing risk factor for impaired incision healing[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn their retrospective analysis of elective lumbar degenerative surgery cases, Klemencsic et al. identified age over 54 years and a BMI greater than 28 kg/m\u0026sup2; as independent risk factors for SSI. Among the 723 eligible patients included in the study, 25 developed spinal SSI. The authors suggest that patients with a higher BMI possess larger amounts of subcutaneous adipose tissue, which necessitates greater retraction force during surgery. This thicker layer of fat tissue consequently increases the surface area of necrotic tissue. Diminished tissue perfusion and necrosis impair optimal neutrophil function, facilitating the colonization of bacterial pathogens in the wound and leading to the development of SSI[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHigh BMI is an independent risk factor for PWH, which may be closely associated with the physiological characteristics of obese individuals[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These patients typically possess a thick subcutaneous fat layer, and fat liquefaction can occur during surgery, complicating the procedure and potentially impairing the normal healing process of the incision[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, the frequent presence of metabolic comorbidities (including diabetes mellitus and hyperlipidemia) in obese patients may impair nutritional status and immune competence, thereby exacerbating wound healing impairment[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Consequently, for patients with a high BMI, it is essential to conduct a comprehensive preoperative assessment, optimize the surgical plan, and enhance postoperative care and nutritional support to mitigate the incidence of PWH.\u003c/p\u003e\u003cp\u003eMale gender, as an independent risk factor for PWH, potentially mediated by gender-specific differences in skin architecture and physiological characteristics. Compared to females, male patients typically exhibit thicker skin and reduced vascularity, potentially compromising blood perfusion and nutrient delivery to the wound site, thereby predisposing to impaired healing[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Research by Sang et al. supports our view. They retrospectively analyzed 3,080 patients who underwent PLIF surgery and found that male was one of the risk factors for SSI[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExperimental studies have established the inhibitory role of androgens in cutaneous wound healing, manifesting as delayed healing in male murine models. Notably, this inhibitory effect is reversible through exogenous androgen administration in castrated murine models[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, the role of the androgen receptor (AR) in skin cells has garnered significant attention. Current evidence suggests AR plays a pivotal role in regulating cutaneous wound healing processes. Targeted AR knockout models demonstrate profound effects on wound healing dynamics, including impaired epidermal migration, suppressed re-epithelialization, enhanced apoptosis, and reduced epithelial proliferation and collagen synthesis[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMale subjects exhibit more intense and sustained infiltration of neutrophils and macrophages at wound sites[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Experimental studies demonstrate significantly elevated macrophage counts and pro-inflammatory cytokine levels (particularly TNF-α) in male murine wound models compared to female counterparts. This discrepancy may contribute to an exaggerated and extended inflammatory response during the wound healing process. In terms of cytokine secretion, females typically produce greater amounts of anti-inflammatory cytokines, such as IL-10, which aid in mitigating inflammatory responses and promoting wound healing. Conversely, male subjects exhibit elevated secretion of pro-inflammatory mediators (including TNF-α and IL-1β), which may contribute to delayed wound healing.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral limitations should be acknowledged in this study. First, the retrospective nature of data collection from medical records may introduce information bias and data incompleteness. Second, the single-center design and patient selection from a single institution may limit the generalizability of our findings. This relatively homogeneous sample source may introduce selection bias, thereby limiting the generalizability of the study results. Furthermore, despite the multifactorial nature of PWH following lumbar surgery, our analysis was limited to baseline characteristics, clinical parameters, and imaging features. Future research should aim to expand the sample size, enhance the research design, and explore the risk factors for poor postoperative incision healing from lumbar spine surgery from multiple dimensions, thereby providing a more comprehensive and clinically accurate reference.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eI declare that the authors have no competing interests, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol received ethical approval from the institutional review board of 960 Hospital (960H2022070).\u003c/p\u003e\n\u003cp\u003eDue to the retrospective nature of this study, the requirement for informed consent was waived by the reviewing board, as all patient data were de-identified and analyzed in a manner that ensures confidentiality, adhering to the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI declare that the authors have no competing interests, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Shandong Provincial Medical and Health Development Plan (No. 202404071129).\u003c/p\u003e\n\u003cp\u003eThis study was supported by the fund from the Science and Technology Innovation Team of 960 Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the manuscript. Study conception and design: WH; acquisition and analysis of data: WX, GL, JW; methodology: WX, YL, WH; funding acquisition: LW; writing\u0026mdash;original draft: WX, YL; writing\u0026mdash;review and editing: YL, WH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRavindra VM, Senglaub SS, Rattani A, Dewan MC, H\u0026auml;rtl R, Bisson E, Park KB, Shrime MG. Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume. Global Spine J. 2018;8(8):784\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. 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Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96(1):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEming SA, Martin P, Tomic-Canic M. Wound repair and regeneration: Mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi J, Jia G, Dong W, Zhao F, Zhao Z, Yu X, Zhu C, Li J, Liu S, Jiang X, et al. Incidence and risk factors of delayed wound healing in patients who underwent unicompartmental knee arthroplasty. Int Wound J. 2023;20(2):508\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhong C, Lu W, Xie W, Jiao W. A prediction model of risk factors of poor wound healing after craniocerebral surgery. Pakistan J Med Sci. 2023;39(6):1835\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM, Errico TJ, Kim HJ, et al. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg-Spine. 2016;25(1):1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJensen TS, Karppinen J, Sorensen JS, Niinim\u0026auml;ki J, Leboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17(11):1407\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEzzati M, Bentham J, Di Cesare M, Bilano V, Bixby H, Zhou B, Stevens GA, Riley LM, Taddei C, Hajifathalian K, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang G, Zhu Y, Zhang M, Qin W, Xiong T, Ou Y. The risk factors of the postoperative poor wound healing in spinal tuberculosis patients: A single centre retrospective cohort study. Int Wound J. 2022;19(7):1669\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen H, Wu Z, Chen D, Huang F. Correlation between blood glucose level and poor wound healing after posterior lumbar interbody fusion in patients with type 2 diabetes. Int Wound J. 2024;21(1):e14340.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlemencsics I, Lazary A, Szoverfi Z, Bozsodi A, Eltes P, Varga PP. 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J Pediatr Urol. 2019;15(6):635\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWee WKJ, Low ZS, Ooi CK, Henategala BP, Lim ZGR, Yip YS, Vos MIG, Tan WWR, Cheng HS, Tan NS. Single-cell analysis of skin immune cells reveals an Angptl4-ifi20b axis that regulates monocyte differentiation during wound healing. Cell Death Dis. 2022;13(2):180.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGawronska-Kozak B, Kopcewicz M, Machcinska-Zielinska S, Walendzik K, Wisniewska J, Drukała J, Wasniewski T, Rutkowska J, Malinowski P, Pulinski M. Gender Differences in Post-Operative Human Skin. Biomedicines 2023, 11(10).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7317302/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7317302/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e This study aimed to identify the risk factors associated with poor wound healing (PWH) following posterior lumbar spine surgery in patients with lumbar degenerative diseases (LDD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e From January 2019 to January 2023, consecutive patients who underwent lumbar spine surgery at our hospital were retrospectively studied. Data on patients' baseline characteristics, clinical information, and imaging findings were collected, and multiple logistic regression analysis was employed to assess the risk factors for PWH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 1050 patients were included in the final analysis, of whom 79 exhibited post-operative PWH complications, while 971 demonstrated normal healing. The results of the multiple regression analysis indicated that male sex (OR=2.188, 95% CI=1.304-2.670, p\u0026lt;0.05)and high body mass index (BMI) (OR=1.882, 95% CI 1.147-3.089, p\u0026lt;0.05) were independent risk factors for PWH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e Male patients and those with a high BMI are at increased risk of experiencing PWH following lumbar spine surgery. These findings underscore the importance of closely monitoring these high-risk patient groups in clinical practice and implementing appropriate preventive measures to enhance postoperative outcomes.\u003c/p\u003e","manuscriptTitle":"Risk Factors for Poor Wound Healing Following Posterior Lumbar Spine Surgery in Patients with Lumbar Degenerative Diseases: A Retrospective Case-Control Study ShortTitle: Risk Factors for Poor Wound Healing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:18:52","doi":"10.21203/rs.3.rs-7317302/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cba93d5-3c42-4661-8f4a-fc806fde162d","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-15T03:53:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 06:18:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7317302","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7317302","identity":"rs-7317302","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}