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The Value of Plastic Surgeon Spinal Closures

A Review of 782 Spine Cases

Xu, Hope BA; Rozanski, Collin BA; Taub, Peter J. MD, FACS, FAAP

doi: 10.1097/SAP.0000000000001831
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Background The role of the plastic surgeon in wound management after complications from previous spinal surgeries is well established.

Purpose The present study evaluates wound complications after plastic surgeon closure of the primary spinal surgery in a large patient population.

Study Design and Setting This is a retrospective review of spine surgery patients undergoing plastic surgeon closure of spine surgeries at a single tertiary care center.

Patient Sample 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 intraoperatively.

Outcome Measures The outcomes are physiologic measures, including intraoperative and postoperative complications, hospital length of stay, and 30-day readmissions and reoperations.

Methods Outcomes in this sample were compared with previously published outcomes using 2-sample z tests. The authors have no conflicts of interest.

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 with a study of 22,430 patients in the American College of Surgeons National Surgery Quality Improvement Program 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).

Conclusions Thirty-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 conducted to determine whether the increased cost of plastic surgeon involvement in these cases is offset by the savings represented by fewer readmissions and complications.

From the Department of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Received October 9, 2018, and accepted for publication, after revision December 16, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Hope Xu, BA, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029. E-mail: hope.xu@icahn.mssm.edu.

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