Incidence, Impact, and Risk Factors for 30-Day Wound Complications Following Elective Adult Spinal Deformity Surgery

Lee, Nathan J.; Shin, John I.; Kothari, Parth; Kim, Jun; Leven, Dante M.; Steinberger, Jeremy; Guzman, Javier Z.; Skovrlj, Branko; Caridi, John M.; Cho, Samuel K.

doi:10.1177/2192568217699378

Cited by 34 publications

(37 citation statements)

References 41 publications

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“…16 Elevated ASA class has also previously been reported as a risk factor for postoperative complications in spinal fusion surgery in other studies. 16,[18][19][20] Our findings suggest an association between incurring increased complications and extended operative times, which is corroborated by previous studies identifying longer operation time as predictive of developing postoperative complications. [18][19][20] Our finding that smoking is associated with surgical delay is not surprising considering the myriad of deleterious effects smoking has on general health conditions.…”

Section: Discussionsupporting

confidence: 90%

“…16,[18][19][20] Our findings suggest an association between incurring increased complications and extended operative times, which is corroborated by previous studies identifying longer operation time as predictive of developing postoperative complications. [18][19][20] Our finding that smoking is associated with surgical delay is not surprising considering the myriad of deleterious effects smoking has on general health conditions. 21,22 This association corresponds with our other findings that advanced age and an elevated ASA class, both factors which are indicative of poorer health, are also more likely to lead to a surgical delay.…”

Section: Discussionsupporting

confidence: 90%

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The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity

Wade

Fredericks

Elsenbeck

et al. 2020

Global Spine Journal

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Study Design: Retrospective database review. Objectives: The incidence and risk factors for surgical delay of multilevel spine fusion for adult spinal deformity (ASD), and the complications corresponding therewith, remain unknown. The objectives of this study are to assess the incidence and risk factors for unexpected delay of elective multilevel spinal fusions on the date of surgery as well as the postoperative complications associated with these delays. Methods: We conducted a retrospective review of the ACS-NSQIP database on patients undergoing elective spinal instrumentation of greater than 7 levels for ASD between the years 2005 and 2015. Preoperative risk factors for delay and postoperative complications were compared between the cohorts of patients with and without surgical delays. Results: Multivariate analysis of 1570 (15.6%) patients identified advanced age, male sex, American Society of Anesthesiologists (ASA) Class 4, and history of smoking as independent risk factors for delay. Patients experiencing surgical delay demonstrated longer operative times, increased intraoperative bleeding, longer hospitalizations, and significantly higher rates of postoperative complications. Patients experiencing delay demonstrated an almost 7-fold increase in mortality rate (3.4% vs 0.5%, P < .001). Conclusions: Delays in elective surgical care for spinal deformity are negatively related to patient outcomes. Advanced age, male sex, increased ASA class, and a history of smoking cigarettes place patients at risk for surgical delay of multilevel spinal fusion. Patients experiencing surgical delay are at higher risk for postoperative complications, including a 7-fold increase in mortality. These findings suggest that ASD surgery should be postponed in patients experiencing a delay, until modifiable risk factors can be medically optimized, and perhaps postponed indefinitely in those with nonmodifiable risk factors.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity

Wade

Fredericks

Elsenbeck

et al. 2020

Global Spine Journal

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“…Lee et al reported a decrease in wound infection rate after spinal deformity surgery between 2010 and 2014, from 3.3% to 2.4%. 11 Likewise, Passias et al found a significant decrease in postoperative complications (from 26.7% to 8.6%; p < 0.001) for patients over 75 years of age undergoing deformity surgery between 2003 and 2012, even though the case complexity was found to actually have increased. 17 Another potential important bias results from the studies by Elder et al 5 and Ishida et al, 9 both stemming from the same institution.…”

Section: Discussionmentioning

confidence: 93%

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Ramos

Nakhla

Sciubba

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEIn a meta-analysis, the authors sought to compare outcomes after iliac screw (IS) versus S2 alar-iliac (S2AI) screw fixation in adult patients.METHODSA PubMed/MEDLINE database search was performed for studies comparing IS and S2AI screw fixation techniques in adults. Levels of evidence were assigned based on the North American Spine Society guidelines. Three outcomes were examined: 1) revision surgery rate secondary to mechanical failure or wound complications, 2) surgical site infection rate, and 3) screw prominence/pain. Data were pooled and outcomes compared between techniques. Absolute risk reductions (ARRs) were also calculated for outcome measures.RESULTSFive retrospective cohort studies (all level III evidence) were included in our analysis. A total of 323 adult patients were included—147 in the IS group (45.5%) and 176 in the S2AI group (54.5%). Overall, revision surgery due to mechanical failure or wound complications was needed in 66 of 323 patients (revision surgery rate 20.4%)—27.9% in the IS group and 14.2% in the S2AI group (13.7% ARR; p < 0.001). Four studies reported wound infections among 278 total patients, with an infection rate of 12.6% (35/278)—25.4% in the IS group and 2.6% in the S2AI group (22.8% ARR; p < 0.001). Three studies examined development of screw prominence/pain; combined, these studies reported screw prominence/pain in 21 of 215 cases (9.8%)—18.1% in the IS group and 1.8% in the S2AI group (16.3% ARR; p < 0.001).CONCLUSIONSS2AI screw fixation in adults has a significantly lower mechanical failure and complication rate than IS fixation based on the current best available evidence.

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“…Three studies report cumulative incidence of wound complications following ≥3 level posterior spine fusion ( Table 1 ). 15 – 17 Mean ages ranged from 59 to 64 years with the proportion of males ranging from 39% to 68%. Follow-up times for 2 studies were 1 month and 2 years.…”

Section: Resultsmentioning

confidence: 99%

Is There an Optimal Wound Closure Technique for Major Posterior Spine Surgery? A Systematic Review

Yılmaz

Blecher

Moisi

et al. 2018

Global Spine Journal

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Study Design:Systematic review.Objectives:In patients undergoing posterior spinal fusion: (1) What are the types and risks of wound complications in major (≥3 levels) surgery, and does the risk vary by number of levels fused? (2) What types of fascial closure result in the fewest wound complications? (3) What subcutaneous closure technique is more effective in preventing wound complications for obese patients (body mass index >30 kg/m2)? (4) What type of skin closure results in the fewest wound complications? (5) What type of dressing results in the fewest wound complications?Methods:Electronic databases and reference lists of key articles were searched from January 1, 2000 to December 4, 2017 to identify studies meeting inclusion criteria.Results:Six lower quality retrospective studies (evidence level III) met the inclusion criteria. The risk of wound complications in patients with ≥3 level posterior spine fusion ranges from 1.5% to 3.7% depending on the definition of wound complications. Skin closure with sutures resulted in fewer wound infections compared with staples (0.0% vs 8.0%, P = .023). We were unable to demonstrate an association between the number of levels fused and infection risk. Wound infections, primarily superficial, occurred less frequently with Silverlon dressing versus routine dressing.Conclusions:We were unable to determine if infection risk changed with increasing number of levels fused. There is a lack of evidence for optimal wound closure technique in posterior spine surgery. Several questions still remain unanswered, such as the optimal fascial closure technique or the optimal subcutaneous closure technique in obese patients.

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Incidence, Impact, and Risk Factors for 30-Day Wound Complications Following Elective Adult Spinal Deformity Surgery

Cited by 34 publications

References 41 publications

The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity

The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity

Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis

Is There an Optimal Wound Closure Technique for Major Posterior Spine Surgery? A Systematic Review

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