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

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

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Study Design: Case-control study. Objective: To determine the incidence, impact, and risk factors for wound complications within 30 days following elective adult spinal deformity surgery. Methods: Current Procedural Terminology and International Classification of Diseases, Ninth Edition, diagnosis codes were used to query the database for adults who underwent spinal deformity surgery from 2010 to 2014. Patients were separated into groups of those with and without wound complications. Univariate analysis and multivariate logistic regression were used to analyze the influence of patient factors, operative variables, and clinical characteristics on the incidence of postoperative wound complication. This study was qualified as exempt by the Mount Sinai Hospital Institutional Review Board. Results: A total of 5803 patients met the criteria for this study. Wound complications occurred in 140 patients (2.4%) and were significantly associated with other adverse outcomes, including higher rates of unplanned reoperation (P <.0001) and prolonged length of stay (P <.0001). Regardless of fusion length, wound complication rates were higher with a posterior approach (short = 2.7%; long = 3.7%) than an anterior one (short = 2.2%; long = 2.7). According to the multivariate analysis, posterior fusion (odds ratio [OR] = 1.8; P =.010), obese class II (OR = 1.7; P =.046), obese class III (OR = 2.8; P <.0001), preoperative blood transfusion (OR = 6.1; P =.021), American Society of Anesthesiologists class ≥3 (OR = 1.7; P =.009), and operative time >4 hours (OR = 1.8; P =.006) were statistically significant risk factors for wound complications. Conclusion: The 30-day incidence of wound complication in adult spinal deformity surgery is 2.4%. The risk factors for wound complication are multifactorial. This data should provide a step toward developing quality improvement measures aimed at reducing complications in high-risk adults.

Original languageEnglish
Pages (from-to)417-424
Number of pages8
JournalGlobal Spine Journal
Volume7
Issue number5
DOIs
StatePublished - 1 Aug 2017

Keywords

  • American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)
  • adult spinal deformity
  • infection
  • spinal fusion
  • wound complication

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