JBJS - 2026-07-06 - Journal Article
Timing of Vascular Endothelial Growth Factor Inhibitor Reinitiation and Risk of Wound Complications in Spinal Metastasis Surgery.
Su CC, Pan YT, Lin YP, Chou CC, Yen HK, Tsai HC, Hsieh HC, Lin WH, Hu MH, Groot OQ
Topics
Key Takeaway
Perioperative VEGFi use carries an OR of 4.12 for wound complications after spinal metastasis surgery, and reinitiation within 40 days postoperatively is associated with significantly higher complication rates than reinitiation after 40 days.
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Summary
This study asked whether timing of postoperative VEGFi reinitiation affects wound complication rates in spinal metastasis surgery. Among 1,164 patients at a single Taiwanese tertiary center (2010–2022), 25.9% developed wound complications within 90 days; multivariable logistic regression identified VEGFi use (OR 4.12), diabetes (OR 4.58), ECOG ≥2 (OR 3.07), and antimetabolite use (OR 2.24) as independent risk factors. ROC and Fisher exact test analyses identified 40 days as the threshold below which VEGFi reinitiation significantly elevates complication risk compared to nonusers.
Key Limitation
Single Taiwanese tertiary center limits generalizability across different tumor histologies, surgical complexity, wound closure techniques, and healthcare systems where VEGFi agents and dosing protocols may differ.
Original Abstract
BACKGROUND
Vascular endothelial growth factor inhibitors (VEGFi) are widely used for metastatic cancer management but are known to impair wound-healing. In spinal metastasis surgery, postoperative wound complications remain a clinical challenge, and the perioperative management of systemic antineoplastic therapies remains poorly defined. Current recommendations regarding postoperative VEGFi reinitiation are largely consensus-based and range from 28 to 40 days. The aims of this study were to evaluate the association between perioperative antineoplastic therapies and wound complications and to define the optimal timing of postoperative VEGFi reinitiation.
METHODS
This retrospective cohort study included 1,164 Taiwanese patients (684 male and 480 female; median age, 60.7 years [interquartile range, 51.5 to 68.8 years]) who underwent spinal metastasis surgery at a single tertiary center between 2010 and 2022. The outcome was postoperative wound complications within 90 days. Multivariable logistic regression was used to identify independent risk factors. The association between the timing of postoperative VEGFi reinitiation and wound complications was assessed using receiver operating characteristic curve analysis and the Fisher exact test.
RESULTS
Wound complications occurred in 301 patients (25.9%). Multivariable analysis identified diabetes mellitus (odds ratio [OR] = 4.58; p < 0.001), poor performance status (Eastern Cooperative Oncology Group score ≥2; OR = 3.07; p = 0.002), perioperative use of VEGFi (OR = 4.12; p < 0.001), and perioperative use of antimetabolites (OR = 2.24; p = 0.04) as independent risk factors. Patients reinitiating VEGFi within 40 days had higher complication rates than both nonusers and those reinitiating VEGFi after 40 days, with the former comparison reaching statistical significance.
CONCLUSIONS
One-quarter of the patients undergoing spinal metastasis surgery experienced postoperative wound complications. Perioperative use of VEGFi was an independent predictor, and our results suggest that there should be a postoperative cessation interval of 40 days to reduce wound-related risk. Clinicians should balance the oncologic benefits of early VEGFi reinitiation against the heightened risk of complications.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.