Surgical factors associated with prolonged hospitalization after reconstruction for oncological spine surgery

Hannah M. Carl, Devin O'Brien-Coon, Nicholas A. Calotta, Rachel Pedreira, Justin Michael Sacks

Research output: Contribution to journalArticle

Abstract

Background: Posterior trunk reconstruction is increasingly possible as a result of advances in spinal instrumentation, reconstructive approaches, and perioperative critical care. Extensive cases often require a muscle flap or complex closure to obliterate dead space. Postsurgical wound complications and subsequent reoperations can lead to neural injury, higher hospital costs, and longer hospitalizations. We aim to identify risk factors that are associated with increased length of stay (LOS) for patients receiving flaps to close a spinal defect. Methods: A single institution, retrospective cohort study was performed on all patients from 2002 to 2014 who received a muscle flap to close a spine defect. Medical and perioperative variables that were significantly associated with LOS (P < 0.05) in univariate analysis were included in a stepwise regression model. Results: A total of 288 cases were identified. Presence of instrumentation, preoperative chemotherapy, wound dehiscence, cerebrospinal f;uid leak, partial/total flap loss, and medical morbidity occurrence were all independently associated with increased LOS in a combined multivariate model (P < 0.02 for each of the 6 variables). Importantly, Kaplan-Meier analysis demonstrated that postoperative wound dehiscence increased LOS by 12 days. Conclusions: Spinal tumor resections often create large cavitary defects that necessitate the use of muscle flaps for closure. Patients who have received adjuvant chemotherapy require instrumentation, or those who develop specific wound-related or medical complications are at increased risk for prolonged hospitalization after spinal reconstruction. Thus, implementing measures to mitigate the occurrence of these adverse events will reduce costs and decrease the length of hospitalization.

Original languageEnglish (US)
Article number1271
JournalPlastic and Reconstructive Surgery - Global Open
Volume5
Issue number4
DOIs
StatePublished - Jan 1 2017

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Hospitalization
Spine
Length of Stay
Wounds and Injuries
Muscles
Perioperative Care
Hospital Costs
Kaplan-Meier Estimate
Critical Care
Adjuvant Chemotherapy
Reoperation
Cohort Studies
Retrospective Studies
Morbidity
Costs and Cost Analysis
Drug Therapy
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical factors associated with prolonged hospitalization after reconstruction for oncological spine surgery. / Carl, Hannah M.; O'Brien-Coon, Devin; Calotta, Nicholas A.; Pedreira, Rachel; Sacks, Justin Michael.

In: Plastic and Reconstructive Surgery - Global Open, Vol. 5, No. 4, 1271, 01.01.2017.

Research output: Contribution to journalArticle

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