Tattooed Skin at Surgical Site Increases SSI Risk in Spine Surgery: Study
Spine Surgery
France: Researchers have found in a new study that tattooed skin at the operative site is associated with nearly a threefold higher risk of surgical site infection (SSI) after spine surgery. These findings highlight the importance of routine preoperative documentation of tattoos and the implementation of individualized perioperative infection-prevention strategies for patients undergoing spinal procedures.
The findings, published in the Journal of Hospital Medicine, are from a study by Keyvan Mostofi, MD, PhD, and Gianluca Caragliano, MD, of Centre Clinical, Soyaux, France, which examined whether tattoos overlying the planned surgical incision increase the risk of surgical site infection (SSI) after spine surgery.
For this purpose, the researchers conducted a retrospective cohort study of 1,578 consecutive spine surgeries performed between November 2015 and December 2025. Patient demographics, ASA physical status, and the presence of tattoos at the operative site were recorded, and SSIs were diagnosed using CDC/NHSN criteria.
Overall, 64 SSIs (4.06%) were identified. Infection occurred in 10.2% of patients with tattoos at the operative site compared with 3.65% of those without tattoos, indicating that tattoos were associated with an approximately threefold increased risk of surgical site infection.
The study led to the following findings:
- Most tattooed patients who developed surgical site infections had low ASA scores (1–2), indicating that the increased infection risk was unlikely to be explained by poorer overall health.
- The median interval between tattoo placement and surgery was three years, suggesting the increased risk was not related to recent tattooing or acute skin changes.
- Older age was significantly associated with a higher risk of surgical site infection.
- Sex, diabetes, body mass index (BMI), and smoking were not significantly associated with surgical site infection in this study.
- Staphylococcus aureus was the most common causative organism, accounting for more than half of all surgical site infections.
- The researchers suggest that tattoos may increase infection risk through persistent skin changes, altered local immune responses, or tissue characteristics, although the exact mechanism remains unclear and requires further investigation.
The study was limited by its retrospective design and the inclusion of procedures performed by a single surgeon at one center, which may limit the generalizability of the findings. As an observational study, it also cannot establish a direct cause-and-effect relationship, and the possibility of residual confounding cannot be completely excluded.
Overall, the findings identify tattooed skin over the operative field as a potential independent risk factor for surgical site infection following spine surgery. The researchers suggest that documenting tattoos during preoperative assessment and considering tailored infection-prevention strategies may help reduce postoperative complications in selected patients.
Reference:
MOSTOFI, K., & CARAGLIANO, G. (2026). Surgical Site Infections in Spine Surgery: A Retrospective Study of 1,578 Procedures with Identification of Tattooed Skin as a Novel Risk Factor Associated with Surgical Site Infection. Journal of Hospital Infection. https://doi.org/10.1016/j.jhin.2026.06.006
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