Safety of Perioperative Immunotherapy Use on Wound Healing After Surgery for Spinal Metastases

BACKGROUND AND OBJECTIVES: Immunotherapy has become a mainstream part of cancer care, but the immune system is also critical for wound healing. Dysregulating immunity to treat cancer raises concerns about potential iatrogenic effects on postoperative recovery. Despite its growing use, immunotherapy's impact on surgical wound healing remains poorly characterized. In this study, we investigate the relationship between immunotherapy and wound healing in patients after surgery for spinal metastases. METHODS: Patients 18 years and older who underwent surgery for spinal metastases from 2012 to 2024 at a comprehensive cancer center were retrospectively evaluated. Demographics, comorbidities, tumor histology, and therapy regimens were catalogued. Instances of "perioperative" (within 12 months before or 3 months after surgery) immunotherapy, radiotherapy, targeted therapy, and chemotherapy were noted. The primary outcome was wound complications, stratified by level of management: antibiotics with routine local care, nonroutine local care, or revisions surgery. RESULTSINALL,: 367 patients were included (mean age 60.5 ± 12.1 years) where the most common primary pathologies were lung (18.0%) and prostate (16.1%). Perioperative immunotherapy was administered to 54/367 (14.7%) patients, predominantly immune checkpoint inhibitors (94.4%). Patients who received immunotherapy had mostly similar complication rates (7.4%) than those who did not (12.8%; P = .262). Furthermore, the time it took until wound issues developed did not differ significantly (immunotherapy 0.8 ± 0.6 vs nonimmunotherapy 1.2 ± 0.7 months; P = .306). On multivariate analysis, patients with sacral location for surgery (odds ratio 5.84, 95% CI 1.35-25.30, P = .018) had increased odds of wound complications. Perioperative immunotherapy use did not elevate the odds of wound complications (odds ratio 0.40, 95% CI 0.09-1.69, P = .211). Perioperative radiation, chemotherapy, and targeted therapy were not associated with an elevated risk of complications. CONCLUSION: Perioperative immunotherapy use for spinal metastases seems clinically safe without major wound healing implications. These findings suggest immunotherapy can be safely administered to patients during surgical planning for spinal metastases.