Wound Complications Following Plastic Surgeon Closure of Index Spinal Surgeries
Elizabeth H. Weissler, BA, Felipe Molina-Burbano, BA, Michael J. Ingargiola, MD, Nachi Gupta, MD, PhD, Christian Piņa, MS, Peter J. Taub, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Purpose: The role of plastic surgery in wound closure following complications from previous spinal surgery is well established. This study evaluates wound complications following plastic surgeon closure of the index spinal case.
Methods: Spinal surgeries performed by a single spinal surgeon and closed by a single plastic surgeon at a large academic hospital were reviewed. Outcomes were compared with published NSQIP outcomes.
Results: 520 spinal surgeries were reviewed, of which 310 (60%) were lumbar and 210 (40%) cervical. 126 patients (24%) had prior spinal operations. The average patient age was 55 years and the average BMI was 30. 41% of patients had BMIs above 30. 191 patients had hypertension, 78 had diabetes, 42 had coronary artery disease, and 10 had COPD. Post surgery, there were 2 superficial wound infections, 2 deep wound infections, and 1 wound dehiscence requiring reoperation. There were 12 reoperations within 30 days and 7 readmissions over the same period.
Conclusions: Though plastic surgeon involvement in spinal surgery is often after the development of complications, plastic surgeon closure of the index spinal case lead to decreased wound complication, readmission, and reoperation rates when compared with outcomes published from NSQIP in similar populations. Given the cost-consciousness of today’s healthcare climate, these improved complication, readmission, and reoperation rates may translate into higher value care and should be examined further.
|Table 1: Plastic surgeon closures of index spinal surgeries and outcomes reported in the literature|
|Outcome||Plastic surgeon index closures N (%)||NSQIP (%)||Meta-analysis (%)|
|Kimmell et al||Bekelis et al||Bohl et al||Bohl et al||McCutcheon et al||Bernatz et al|
|Number of cases||310 Lumbar cases||210 Cervical cases||520 total cases||22,430 cases||13,660 cases||12,067 ACDF cases||11,807 PLF cases||9,719 cases||488,049 cases|
|Superficial wound infection||2 (0.64)||0||2 (0.38)||1.20||n/a||0.41 (infections combined)||1.76 (infections combined)||1.24||n/a|
|Deep wound infection||1 (0.32)||1 (0.47)||2 (0.38)||0.7||0.3||0.68||n/a|
|Wound dehiscence||1 (0.32)||0||1 (0.19)||0.3||n/a||n/a||n/a||0.35||n/a|
|Reoperation within 30d||12 (3.8)||0||12 (2.31)||n/a||3.15||n/a||n/a||3.50||n/a|
|Readmission within 30d||7 (2.26)||0||7 (1.34)||n/a||n/a||n/a||n/a||n/a||5.50|
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