Tang Anthony J, Kim Dylan K, Wright Matthew A, Chou Dean, Rohde Christine H, Chan Andrew K
1Department of Neurosurgery.
2Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York.
J Neurosurg Spine. 2025 Apr 18;43(1):108-121. doi: 10.3171/2025.1.SPINE241090. Print 2025 Jul 1.
Spinal fusion is associated with risks of surgical site infection and wound dehiscence. Muscle flap reconstruction during surgery may mitigate these risks. While the benefits of muscle flap reconstruction have been established, sociodemographic and hospital-level influences on access to this procedure remain unexplored. This study identifies sociodemographic predictors of muscle flap reconstruction after spinal fusion surgeries using a nationwide database.
Patients who underwent spinal fusion of two or more vertebral levels (n = 606,408) were identified from the 2012-2020 National Inpatient Sample database. The primary investigated outcome was utilization of muscle flap reconstruction. Cases without and with muscle flap reconstruction were 2:1 propensity score matched based on covariates for clinical severity and surgical complexity. Binary logistic regression identified significant sociodemographic and hospital-level predictors of receiving muscle flap reconstruction (p < 0.05).
Of 606,408 discharges with spinal fusion cases, 1991 (0.3%) included muscle flap reconstruction. After matching (n = 5973), patient-level factors including private insurance status, residence in large metropolitan counties, and high median zip code income quartile, and hospital-level factors including urban teaching hospital status, higher institutional plastic surgery case volume, and private not-for-profit hospital ownership, all predicted a higher likelihood of muscle flap reconstruction (p < 0.05).
Multiple sociodemographic variables predict use of muscle flap reconstruction after spinal fusion surgery. These disparities may stem from multiple underlying factors, including lack of access to specialized plastic surgery care and centralization of more complex cases at quaternary care hospitals. A better understanding of these factors may help inform further efforts to increase access to muscle flap reconstruction, thereby reducing the risk of wound healing complications.
脊柱融合术与手术部位感染和伤口裂开的风险相关。手术期间的肌皮瓣重建可能会降低这些风险。虽然肌皮瓣重建的益处已得到证实，但社会人口统计学和医院层面因素对该手术可及性的影响仍未得到探讨。本研究使用全国性数据库确定脊柱融合手术后肌皮瓣重建的社会人口统计学预测因素。
从2012 - 2020年全国住院患者样本数据库中识别出接受两个或更多椎体节段脊柱融合术的患者（n = 606,408）。主要研究结局是肌皮瓣重建的应用情况。根据临床严重程度和手术复杂性的协变量，对未进行和进行肌皮瓣重建的病例按2:1的倾向评分进行匹配。二元逻辑回归确定了接受肌皮瓣重建的显著社会人口统计学和医院层面预测因素（p < 0.05）。
在606,408例脊柱融合手术出院病例中，1991例（0.3%）包括肌皮瓣重建。匹配后（n = 5973），患者层面因素包括私人保险状况、居住在大城市县以及邮政编码中位数收入四分位数较高，以及医院层面因素包括城市教学医院状况、机构整形外科病例量较高和私立非营利性医院所有权，均预测肌皮瓣重建的可能性更高（p < 0.05）。
多个社会人口统计学变量可预测脊柱融合手术后肌皮瓣重建的使用情况。这些差异可能源于多种潜在因素，包括难以获得专科整形外科护理以及四级护理医院中更复杂病例的集中化。更好地理解这些因素可能有助于为进一步努力增加肌皮瓣重建的可及性提供信息，从而降低伤口愈合并发症的风险。
