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Muscle Flap Closures in Spine Surgery: Predictors of Usage Patterns and Factors Associated With Postoperative Complications From the NSQIP Database.

Publication ,  Journal Article
Price, MJ; Tillis, R; Howell, EP; Ramirez, L; Dalton, T; Baëta, C; Mehta, V; Abd-El-Barr, MM; Karikari, IO; Goodwin, CR; Brown, DA
Published in: Clin Spine Surg
February 1, 2022

STUDY DESIGN: Retrospective cohort study using the National Surgical Quality Improvement Program. OBJECTIVE: The objective of this study was to identify preoperative factors that impact the decision to perform prophylactic muscle flap closure and assess risk factors for wound healing complications in patients undergoing spinal procedures with and without muscle flap closure. SUMMARY OF BACKGROUND DATA: Prior studies suggest that muscle flap closure following complex spine surgery results in a lower risk of wound healing complications. However, these studies have been limited to single institutions and/or surgeons. METHODS: The National Surgical Quality Improvement Program database was queried for all patients undergoing spine surgery between 2005 and 2017 with and without concomitant muscle flaps. Preoperative and perioperative variables were extracted. Univariate and multivariate analyses were performed to assess risk factors influencing surgical site infection (SSI) and wound disruption, as well as to delineate which preoperative factors increased the likelihood of patients receiving flap closures a priori. RESULTS: Concomitant muscle flaps were performed on 758 patients; 301,670 patients did not receive a flap. Overall 29 (3.83%) patients in the flap group experienced SSI compared to 5154 (1.71%) in the nonflap group (P<0.0001). Preoperative steroid use [odds ratio (OR) 0.5; P<0.0001], wound infection (OR 0.24; P<0.0001), elevated white blood cell count (OR 1.034; P<0.0001), low hematocrit (OR 0.94; P<0.0001), preoperative transfusion (OR 0.22; P=0.0068) were significantly associated with utilization of muscle flaps. Perioperative factors including a contaminated wound (OR 4.72; P<0.0001), the American Society of Anesthesiologists classification of severe disease (OR 1.92; P=0.024), and longer operative time (OR 1.001; P=0.0024) were significantly associated with postoperative wound disruption. In addition, after propensity score matching for these factors that increase risk of wound complications, there was no difference in the rates of SSI between the flap and nonflap group. CONCLUSION: Our results suggest that patients with a higher burden of illness preoperatively are more likely to receive prophylactic paraspinal flaps which can reduce the rates of wound-related complications.

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Published In

Clin Spine Surg

DOI

EISSN

2380-0194

Publication Date

February 1, 2022

Volume

35

Issue

1

Start / End Page

E248 / E258

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgical Flaps
  • Spine
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Muscles
  • Humans
 

Citation

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Price, M. J., Tillis, R., Howell, E. P., Ramirez, L., Dalton, T., Baëta, C., … Brown, D. A. (2022). Muscle Flap Closures in Spine Surgery: Predictors of Usage Patterns and Factors Associated With Postoperative Complications From the NSQIP Database. Clin Spine Surg, 35(1), E248–E258. https://doi.org/10.1097/BSD.0000000000001217
Price, Meghan J., Rose Tillis, Elizabeth P. Howell, Luis Ramirez, Tara Dalton, César Baëta, Vikram Mehta, et al. “Muscle Flap Closures in Spine Surgery: Predictors of Usage Patterns and Factors Associated With Postoperative Complications From the NSQIP Database.Clin Spine Surg 35, no. 1 (February 1, 2022): E248–58. https://doi.org/10.1097/BSD.0000000000001217.
Price MJ, Tillis R, Howell EP, Ramirez L, Dalton T, Baëta C, et al. Muscle Flap Closures in Spine Surgery: Predictors of Usage Patterns and Factors Associated With Postoperative Complications From the NSQIP Database. Clin Spine Surg. 2022 Feb 1;35(1):E248–58.
Price, Meghan J., et al. “Muscle Flap Closures in Spine Surgery: Predictors of Usage Patterns and Factors Associated With Postoperative Complications From the NSQIP Database.Clin Spine Surg, vol. 35, no. 1, Feb. 2022, pp. E248–58. Pubmed, doi:10.1097/BSD.0000000000001217.
Price MJ, Tillis R, Howell EP, Ramirez L, Dalton T, Baëta C, Mehta V, Abd-El-Barr MM, Karikari IO, Goodwin CR, Brown DA. Muscle Flap Closures in Spine Surgery: Predictors of Usage Patterns and Factors Associated With Postoperative Complications From the NSQIP Database. Clin Spine Surg. 2022 Feb 1;35(1):E248–E258.

Published In

Clin Spine Surg

DOI

EISSN

2380-0194

Publication Date

February 1, 2022

Volume

35

Issue

1

Start / End Page

E248 / E258

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgical Flaps
  • Spine
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Muscles
  • Humans