Optimizing wound healing following lumbar spine surgery

Area of Science:

• Neurosurgery
• Plastic and Reconstructive Surgery
• Surgical Outcomes Research

Background:

• Increasing prevalence of open lumbar spine surgeries due to aging populations and surgical advancements.
• Need for improved wound complication management in lumbar spine procedures.

Purpose of the Study:

• To compare the outcomes of prophylactic closure by plastic and reconstructive surgery (PRS) service versus standard closure for lumbar spine procedures.
• To evaluate the impact of PRS closure on wound-related complications, readmissions, and infections.

Main Methods:

• Retrospective review of 888 lumbar spine surgery patients closed by PRS (January 2016 - June 2023).
• Comparison with 46,006 matched cases from the National Surgical Quality Improvement Program (NSQIP) database.
• Analysis of demographics, risk factors, operative course, and 30-day postoperative outcomes including surgical site infections (SSI), dehiscence, seroma, hematoma, CSF leak, and medical complications.

Main Results:

• PRS closure group had significantly lower rates of wound-related revisional surgeries (1.2% vs. 2.6%) and readmissions (1.5% vs. 4.2%) compared to the NSQIP group.
• Lower rates of transfusion (2.7% vs. 4.4%) and urinary tract infections (0.2% vs. 1.3%) were observed in the PRS group.
• Logistic regression indicated significantly decreased odds of revisional surgery (ß = 0.587) and any wound infection (ß = 0.503) with PRS closure.

Conclusions:

• Prophylactic closure by plastic and reconstructive surgery significantly reduces wound-related complications, revisional surgeries, and readmissions following lumbar spine procedures.
• The findings support the integration of PRS services for prophylactic wound closure in lumbar spine surgeries to enhance patient outcomes.