"Prophylactic Muscle Flap Closure After Spinal Fusion Improves Outcomes and Reduces Healthcare Costs".
Academic Article
Overview
abstract
BACKGROUND: Spinal degeneration and deformities affect over 27% in US adults, and $14.1 billion is spent annually on spinal fusion to address these pathologies. Wound closure using local muscle flaps has been associated with reduced complication rates, including infection and reoperation. The high prevalence of degenerative deformities and healthcare expenditures highlight the need for resource utilization studies to inform decision-makers on best operative practices. METHODS: A retrospective review was performed on adult patients at our institution who underwent posterior spinal fusion for degenerative or deformity indications between 2019 and 2022. Patients were stratified by the prophylactic use of muscle flap closure, and outcomes were compared between groups. Costs were applied to consumed resources, and univariate and multivariable regression was performed to measure the impact of muscle flaps on overall costs. RESULTS: 520 patients were included; 240 received muscle flap closures. These patients had significantly fewer readmissions (OR 0.49, 95% CI: 0.29, 0.84), reoperations (OR 0.49, 95% CI: 0.26, 0.89), and hardware failures (OR 0.09, 95% CI: 0.00, 0.45) but greater odds of seroma (OR 5.22, 95% CI: 2.12, 15.7). They also had shorter hospital stays (5.4 vs. 6.5 days; p=0.033), but operative time did not vary by closure type. Multivariable regression revealed muscle flap closure was associated with a $7,152 reduction in overall costs per patient (p<0.03). CONCLUSIONS: Muscle flap closure correlates with reduced complication rates while leading to decreased overall costs per patient. These findings support the use of prophylactic muscle flap closure from safety and health economics perspectives.
