Plastic surgeon closure is comparable to orthopedic closure when a perioperative optimization protocol is instituted
Andrew E Grush1, Vamsi E Mohan2, Michelle G Roy1
1Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, 6701 Fannin St, Suite 610, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, 6701 Fannin St, Suite 610, TX, USA.
Insights
Plastic multilayer closure (PMC) did not reduce complications compared to standard orthopedic spine closure (SOC) in pediatric neuromuscular scoliosis surgery. Surgeries using PMC took longer and had more operating room returns.
Area of Science:
- Orthopedic Surgery
- Wound Healing
- Pediatric Spine Deformities
Background:
- Plastic multilayer closure (PMC) is increasingly used for complex spine surgery in patients prone to wound healing issues.
- PMC involves extensive soft tissue manipulation, potentially increasing operative time and complications compared to standard closure.
- A perioperative protocol was implemented to reduce complications in neuromuscular scoliosis (NMS) patients.
Purpose of the Study:
- To evaluate if PMC offers advantages over standard orthopedic spine closure (SOC) in NMS patients, beyond the implemented perioperative protocol.
- To compare postoperative complication rates between PMC and SOC in pediatric patients undergoing spinal fixation.
Main Methods:
- Retrospective cohort study of 81 pediatric patients with neuromuscular scoliosis undergoing spinal fixation.
- Patients were categorized into standard orthopedic spine closure (SOC, n=41) or plastic multilayer closure (PMC, n=40).
- Primary outcome was 90-day postoperative wound complications (SSI, hematoma, dehiscence), with secondary outcomes including respiratory/neuromuscular complications and surgery duration.
Main Results:
- No statistically significant difference in postoperative complication or surgical site infection (SSI) rates between PMC and SOC groups.
- SOC procedures were, on average, 30 minutes shorter than PMC procedures.
- The PMC group experienced more returns to the operating room for additional surgery.
Conclusions:
- In pediatric neuromuscular scoliosis patients, plastic multilayer closure (PMC) did not demonstrate fewer complications than standard orthopedic spine closure (SOC) when a perioperative protocol was in place.
- PMC was associated with longer operative times and increased need for return to the operating room compared to SOC.
Background Context:
Since 2015, plastic multilayer closure (PMC) has been gaining attraction due to improved wound healing outcomes for medically complex patients. Plastic multilayer closure has been readily used for complex spine surgery closures in patients susceptible to wound healing issues (ie, dehiscence, surgical site infection [SSI]). However, PMC requires extensive soft tissue manipulation compared with standard orthopedic spine surgeon closure (SOC) and can result in extended operative times, increased transfusion rates, and more frequent returns to the operating room.
Purpose:
From 2016 to 2019, our institution implemented a perioperative protocol designed to decrease postoperative complication rates in NMS patients. A retrospective cohort study was performed to determine if PMC imparted advantages over SOC above and beyond that from the perioperative protocol.
Study Design/Setting:
Retrospective study at a single academic institution.
Patient Sample:
Eighty-one pediatric patients with neuromuscular scoliosis undergoing spinal fixation surgery.
Outcome Measures:
Postoperative wound complications such as surgical site infection, hematoma, and superficial/deep dehiscence were the main outcome measures. Respiratory and neuromuscular complications along with duration of surgery were also recorded.
Methods:
A retrospective review was conducted of NMS patients undergoing spinal fixation at a single academic pediatric hospital over 4 years. Cases were labeled as SOC (n=41) or PMC (n=40) based on the closure technique applied. Reported 90-day complications were evaluated as the primary outcome.
Results:
Of the 81 reviewed patients, 45 reported complications, roughly equal between the study groups. While we found no statistically significant differences in rates of postoperative complications or SSIs, SOC cases were 30 minutes shorter on average with fewer returns to the operating room for additional surgery.
Conclusions:
With the implementation of our perioperative protocol for NMS patients, PMC did not result in fewer complications than SOC but the surgeries did take longer.
