Predicting Wound Complications Following Plastic Surgeon Closure of Spine Surgeries

Introduction: Spine surgeries continue to grow in popularity, recently increasing by more than 200% in a decade.^[1] At some institutions, plastic surgeons assist spine surgeons with wound closures of index spine procedures. In anticipation of this becoming a more common practice nationwide, the authors sought to determine risk factors for wound complications in this setting.

Methods: Spine surgeries closed by a single plastic surgeon at a large academic hospital were reviewed. Patients 18 years or younger, with invasiveness indices of zero,^[2] current wound infections, or undergoing surgery for management of complications from prior procedures were excluded. Factors significantly associated (p<0.05) with wound complications on univariate analysis were included in a regression model.

Results: Seven hundred eight procedures were done. Twenty-five patients had any wound complication, including 2 superficial infections, 5 deep infections, 7 dehiscences, 4 seromas, and 7 hematomas. Patients requiring intra-operative blood transfusion (OR 2.68, 1.04-6.93) and with ASA ≥3 (OR 3.77, 1.55-9.14) were more likely to have a wound complication. Surgical time was longer (255.9±134 versus 196±98 minutes, p=0.010) and estimated blood loss higher (1039±956 versus 613.5±788 mL, p=0.006) among patients suffering wound complications. In a multivariate logistic regression controlling for EBL, operative time, ASA status, and intra-operative transfusion, only ASA status of 3 or greater predicted complications (p=0.005).

Conclusions: Contrary to papers in the spine literature that have found operative duration, diabetes, hypertension, and age, among other risk factors, predictive of complications, we found that only ASA status of ≥3 was associated.^[3],[4],[5] This may reflect a lack of power, as the ASA classification includes comorbidities and BMI. Patients at increased risk for complications should be managed more aggressively, including prophylactic local muscle flap closure where appropriate.