Wound complications following metastatic spine tumor surgery (MSTS) represent a significant challenge in surgical oncology with reported rates ranging from 1.5 to 30 % [1,2]. These complications can lead to prolonged hospitalization, increased healthcare costs, delayed adjuvant therapy, and potentially compromised survival outcomes [3,4]. As the survival rates for cancer patients continue to improve due to advancements in systemic therapies, optimizing surgical outcomes becomes increasingly critical, particularly in preventing wound complications that can severely impact patient recovery and quality of life [5].

Several risk factors for wound complications after MSTS have been identified including smoking and neoadjuvant therapy [2]. Nutritional and inflammatory status, particularly as measured by serum albumin levels, has been explored as a potential predictor of surgical complications but with conflicting results [6]. Previous studies investigating the impact of albumin on wound complications in this specific patient population have been limited by evidence quality [7], and did not fully account for contemporary advances in surgical technique [8]. Moreover, the relationship between albumin levels and reoperation following MSTS remains unclear [9,10], with the association of albumin with wound-related reoperations not being thoroughly explored before statistically [11]. This knowledge gap is notable, as albumin represents a potentially modifiable factor that could be addressed in perioperative care [12].

While composite nutritional assessment tools such as the Prognostic Nutritional Index have demonstrated utility in predicting surgical outcomes across various oncologic procedures [13,14], we focused specifically on serum albumin for several reasons. Albumin is widely available in routine preoperative testing, making it a practical clinical marker accessible in virtually all surgical settings. It has been reported as an independent predictor of surgical outcomes across multiple surgical specialties [15,16], with established physiological mechanisms linking it directly to wound healing processes [17]. Moreover, unlike composite scores that may incorporate lymphocyte counts or other parameters frequently altered by antineoplastic therapies, albumin provides a more stable assessment of nutritional and inflammatory status in oncologic patients. Therefore, we aimed to investigate the association between preoperative serum albumin level and wound complications following MSTS using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. This analysis may contribute to our understanding of risk factors for wound complications in this patient population.