Prophylactic muscle flap coverage in frail patients undergoing spinal surgery

Area of Science:

• Spinal Surgery
• Surgical Complications
• Patient Risk Stratification

Background:

• Postoperative wound complications are a challenge in complex spinal fusion, especially in patients with comorbidities.
• Prophylactic muscle flap coverage can reduce complications, but optimal patient selection is unclear.
• The modified frailty index (mFI-5) was evaluated for identifying high-risk patients for flap closure.

Purpose of the Study:

• To evaluate the utility of the five-item modified frailty index (mFI-5) scores in identifying patients who may benefit from prophylactic muscle flap closure.
• To assess the impact of prophylactic muscle flap coverage on postoperative complications in frail spinal surgery patients.

Main Methods:

• Utilized the American College of Surgeons National Surgical Quality Improvement Program database (2005-2020).
• Included patients ≥50 years old undergoing posterior-approach spinal surgery with mFI-5 scores ≥2.
• Performed propensity score matching comparing nonflap to flap reconstruction, analyzing outcomes with logistic regression.

Main Results:

• Flap coverage was associated with reduced superficial surgical site infection (SSI) (0.6% vs 3.4%).
• Multivariate analysis showed flap reconstruction independently reduced superficial SSI odds by 94% (OR, 0.062; p = 0.022).
• Higher body mass index independently predicted SSI risk (OR, 1.09; p = 0.003).

Conclusions:

• Prophylactic muscle flap coverage significantly reduces superficial infection in frail patients (mFI-5 scores ≥2) undergoing spinal surgery.
• The mFI-5 provides a standardized framework for identifying high-risk patients who benefit from prophylactic flap closure.