Obesity, Other Factors May Affect Wound Complication Rates After Spinal Surgery

Pediatric patients with congenital or neuromuscular diagnoses have a higher risk of wound complications following spinal fusion surgery compared with patients with idiopathic or infantile diagnoses, according to results of a study.

According to recently presented data by Andrew J. Pugely, MD, patients with specific comorbidities were at much higher risk for wound complications after pediatric spinal surgery.

“The more invasive the procedure — specifically fusion to the pelvis — and obesity and cardiovascular comorbidities were all independently associated with increased risks of wound complications,”Pugely said.

Andrew Pugley

Andrew J. Pugely

From the Pediatric National Surgical Quality Improvement Program, Pugely, Christopher T. Martin, MD, and colleagues identified 1,915 pediatric thoracic or lumbar fusions performed in 2012. They used a univariate analysis to identify associations between risk factors and the incidence of complications. In addition, the investigators used a multivariate logistic regression to identify independent risk factors for complications.

In the patient cohort, they identified 78 wound complications in 67 patients at 30 days postoperatively for a rate of 3.5%. Complications occurred at a mean of 16.7 days to 20.2 days after surgery.

Patients with congenital or neuromuscular diagnoses had higher wound complication rates of 4.35% and 4.67%, respectively, compared with patients with idiopathic (2.7%) or infantile (1.61%) diagnoses, Pugely said.

The investigators noted that risk factors such as high BMI, cardiac disease, undergoing an osteotomy, a history of tracheostomy and fusion that extend to the pelvis were independent risk factors for wound complications. A wound complication occurred in about 10% of patients with a fusion that extended to the pelvis and about 5% of patients who underwent an osteotomy.

Christopher Martin

Christopher T. Martin

Patients with gastrointestinal or pulmonary comorbidities also had a greater risk of wound complications.

“According to our multivariate logistic regression analysis, excessive BMI, cardiac risk factors and fusion to the pelvis all remain significant predictors of wound complication within 30 days, with fairly high odds ratios of 3.8, 3.2 and 3.4,” Pugely said.

Use to counsel patients

Procedural risk factors, such as pelvic instrumentation, spinal osteotomy, prolonged operative time, higher total case relative value units and longer hospital length of stays, resulted in a higher rate of wound complications at 30 days postoperatively, according to the results.

Pugely and colleagues noted that despite factors associated with increased wound complication rates, their study data showed there is a low rate of wound complication rates after pediatric spine surgery. However, they said physicians should use these study data for patient counseling and preoperative risk stratification. – by Robert Linnehan

Disclosure: Pugely reports no relevant financial disclosures.

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