The Value of Plastic Surgeon Spinal Closures: A Review of 782 Spine Cases
Hope Xu, BA1, Collin Rozanski, BA1, Peter J. Taub, MD, FACS, FAAP2.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Department of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Purpose: The role of the plastic surgeon in wound management following complications from prior spinal surgeries is well established. The present study evaluates wound complications following plastic surgeon closure of the primary spinal surgery in a large patient population.
Methods: Retrospective review of spine surgery patients undergoing plastic surgeon closure of spine surgeries at a single tertiary-care center was conducted. Spine surgery patients included those who were referred for plastic surgeon closure due to a) concerns about patient healing potential, b) concerns about difficulty of closure, c) patient request, or d) difficulties with closure intra-operatively. Outcomes in this sample were physiologic measures, including intra- and post-operative complications, hospital length of stay, and 30-day readmissions and reoperations, which were compared to previously published outcomes using two-sample z-tests.
Results: Nine hundred twenty-eight surgeries were reviewed, of which 782 were included. Fourteen patients (1.8%) required readmission with 30 days. This compares favorably to a pooled analysis of 488,049 patients, in which the 30-day readmission rate was found to be 5.5% (z=4.5, p<0.0001). Seven patients (0.89%) had wound infection and 3 (0.38%) wound dehiscence postoperatively, compared to a study of 22,430 patients in the ACS-NSQIP database which had an infection incidence of 2.2% (z=2.5, p=0.0132) and 0.3% dehiscence rate (z=0.4, p=0.6889). The combined incidence of wound complications in the present sample was 1.27%, which is less than the combined incidence of wound complications in the population of 22,430 patients (z=2.2, p=0.029).
Conclusion: 30-day readmissions and wound complications are intensely scrutinized quality metrics that may lead to reduced reimbursements and other penalties for hospitals. Plastic surgeon closure of index spinal cases decreases these adverse outcomes. Further research must be done to determine whether the increased cost of plastic surgeon involvement in these cases is offset by the savings represented by fewer readmissions and complications.
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