Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
World Neurosurg. 2023 Dec;180:e392-e407. doi: 10.1016/j.wneu.2023.09.078. Epub 2023 Sep 26.
Plastic surgery closure with muscle flaps after complex spinal reconstruction has become increasingly common. Existing evidence for this practice consists of small, uncontrolled, single-center cohort studies. We aimed to compare 30-day postoperative wound-related complication rates between flap closure and traditional closure after posterior thoracolumbar fusions (PTLFs) for non-infectious, non-oncologic pathologies using a national database.
We performed a propensity-matched analysis using the 2012-2020 National Surgical Quality Improvement Program dataset to compare 30-day outcomes between PTLFs with flap closure versus traditional closure.
A total of 100,799 PTLFs met our inclusion criteria. The use of flap closure with PTLF remained low but more than doubled from 2012 to 2020 (0.38% vs. 0.97%; P = 0.002). A higher proportion of flap closures had higher American Society of Anesthesiologists classifications and higher number of operated spine levels (all P < 0.001). We included 1907 PTLFs (630 for flap closure; 1257 for traditional closure) in the propensity-matched cohort. Unadjusted 30-day wound complication rates were 1.7% for flap and 2.1% for traditional closure (P = 0.76). After adjusting for operative time, wound complication, readmission, reoperation, mortality, and non-wound complication were not associated flap use (all P > 0.05).
Plastic surgery closure was performed in patients with a higher comorbidity burden, suggesting consultation in sicker patients. Although higher rates of wound and non-wound complications were expected for the flap cohort, our propensity-matched cohort analysis of flap closure in PTLFs resulted in non-inferior odds of wound complications compared to traditional closure. Further study is needed to assess long-term complications in prophylactic flap closure in complex spine surgeries.
在复杂脊柱重建后，使用肌皮瓣进行整形手术闭合已变得越来越普遍。现有证据包括小型、非对照、单中心队列研究。我们旨在使用国家数据库，比较使用皮瓣闭合与传统闭合治疗非传染性、非肿瘤性病变后路胸腰椎融合术（PTLF）后 30 天术后伤口相关并发症的发生率。
我们使用 2012-2020 年国家手术质量改进计划数据集进行倾向匹配分析，比较皮瓣闭合与传统闭合治疗 PTLF 的 30 天结局。
共有 100799 例 PTLF 符合纳入标准。使用皮瓣闭合治疗 PTLF 的比例仍然较低，但从 2012 年到 2020 年增加了一倍以上（0.38%比 0.97%；P=0.002）。皮瓣闭合组中更高比例的患者具有更高的美国麻醉医师协会分级和更多的手术脊柱节段（均 P<0.001）。我们将 1907 例 PTLF（皮瓣闭合 630 例，传统闭合 1257 例）纳入倾向匹配队列。未调整的 30 天伤口并发症发生率为皮瓣组 1.7%，传统闭合组 2.1%（P=0.76）。调整手术时间、伤口并发症、再入院、再次手术、死亡率和非伤口并发症后，皮瓣使用与这些结果均无相关性（均 P>0.05）。
整形手术闭合是在患有更高合并症负担的患者中进行的，这表明在病情更严重的患者中进行咨询。尽管皮瓣组预计会出现更高的伤口和非伤口并发症发生率，但我们对 PTLF 中皮瓣闭合的倾向匹配队列分析显示，与传统闭合相比，伤口并发症的可能性无差异。需要进一步研究评估复杂脊柱手术中预防性皮瓣闭合的长期并发症。
