TOPLINE:

Tattooed skin at the operative site was significantly associated with a nearly threefold increased risk for surgical site infections (SSIs) following spine surgery, supporting the need for systematic preoperative documentation and individualised perioperative protocols.

METHODOLOGY:

• Researchers conducted a retrospective single-centre cohort study to analyse the incidence of SSIs in spinal surgeries and to identify associated risk factors including the presence of tattoos.
• A total of 1578 consecutive spinal procedures in patients (mean age, 61.5 years; 47.1% women) performed by a single senior surgeon between November 2015 and December 2025 in France were assessed.
• Demographics, comorbidities, procedure type, and the presence of tattoos overlying or within 2 cm of the planned incision were prospectively recorded, with tattoo assessment performed by the operating surgeon prior to surgery.
• SSI was diagnosed if at least one of the following was present: purulent drainage, fever with elevated inflammatory markers, positive intraoperative cultures, or contrast-enhanced CT evidence of deep tissue collection.

TAKEAWAY:

• Overall, 64 SSI episodes were recorded, of which 63 were deep or superficial infections with purulent drainage and/or surgical revision.
• A postoperative SSI occurred in 10.2% of tattooed patients (n = 98) vs 3.65% of non-tattooed patients (odds ratio [OR], 3.00; P = .005).
• Tattooed skin at the operative site remained independently associated with SSIs (adjusted OR, 2.84; P = .006).
• Pathogens were identified in 93.8% of cases. Staphylococcus aureus was the most common (55.4%). Among the infected tattooed patients, Staphylococcus species dominated and included more cases of S aureus and few cases of S epidermidis.

IN PRACTICE:

"[The study] findings support consideration of systematic preoperative tattoo documentation, explicit patient counseling, and individualized perioperative management in spinal surgery," the authors wrote.

SOURCE:

The study was led by Keyvan Mostofi, MD, PhD, Department of Neurosurgery, Centre Clinical, Soyaux, France. It was published online on June 18, 2026, in The Journal of Hospital Infection.

LIMITATIONS:

The retrospective single-centre design limited generalisability, and the relatively small infected subgroup reduced the precision of adjusted estimates. Furthermore, although the uniform perioperative protocol limited operator variability, it may also have restricted generalisability to centres using different protocols.

DISCLOSURES:

This study did not receive any specific funding. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.