Risk Factors for Development of Pre- Discharge and Post- Discharge Postoperative Wound Complications Following Anterior Lumbar Fusion Cheirika O. Ukogu, BA; William A. Ranson, BS; Sulaiman Somani, BS; John Di Capua, MHS; Jun S. Kim, MD; Samantha R. Jacobs, BA; Khushdeep S. Vig, BA; Samuel K. Cho, MD 1 Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York
Disclosures Cheirika O. Ukogu, BA Nothing to Disclose Sulaiman Somani, BS Nothing to Disclose William A. Ranson, BS Nothing to Disclose John Di Capua, BS, MHS Nothing to Disclose Jun S. Kim, MD Nothing to Disclose Samantha R. Jacobs, BA Nothing to Disclose Khushdeep S. Vig, BA Nothing to Disclose
Disclosures Samuel K. Cho, MD: Consulting: Zimmer Biomet (B), DePuy Synthes (B), Medtronic (B), Stryker (B); Research Support (Staff and/or Materials): Zimmer Biomet (B, Paid directly to institution/employer); Grants: OREF (D, Paid directly to institution/employer).
Background The timing of postoperative complications following surgery is usually based upon conventional wisdom as opposed to evidence-based data. (i.e. the Wind, Water, Walk, & Wound mnemonic) Risk factors for the complications following spine surgery are well-characterized in the recent literature, but few studies have investigated the timing of these complications. Wound complications following anterior lumbar fusion (ALF) are a serious event, and can impact patient length of stay, increasing the risk of other hospital acquired infections, which inevitably increases hospital costs. Information on the timing of complications may help to optimize early detection and treatment, and ultimately reduce the incidence of these negative events The purpose of this study was to characterize wound complications in patients undergoing ALF with reference to patient discharge. Risk factors associated with pre-discharge wound complications and postdischarge wound complications were analyzed. 4
Methods-Database Retrospective cohort analysis using prospectively collected database American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Multicenter: >500 hospitals of varying socioeconomic location and academic affiliation across the nation High-fidelity data 30-day postoperative morbidity and mortality outcomes 5
Methods Inclusion Criteria: Patients 18 years old undergoing elective ALF (CPT-22558) Cohorts: ALF patients grouped by wound complications occurring before or after discharge. Wound complication = Deep incisional, superficial incisional, and organ space SSI, as well as wound disruptions Data from years 2010-2014 were queried in the ACS NSQIP database. Sample Size 2,707 ALF patients 2642 (97.5%) did not develop a wound complication, 10 (0.4%) complications occurred before discharge 55 (2%) happened following hospital discharge Exclusion Criteria: Age < 18 years old Ventilator dependency Disseminated cancer Radiotherapy for malignancy Central nervous system (CNS) tumors Chemotherapy Emergency operation Pre-operative sepsis Acute renal failure Non-elective surgery Spinal deformity surgery Cases with missing preoperative data were excluded from this study 6
Method-Data Analysis Bivariate analyses were performed to compare the rates of preoperative characteristics and the timing of wound complications between pre-discharge and post-discharge. Pearson's chi-square and Fisher's exact test (where appropriate) were used for categorical variables. Multinomial logistic regression models were employed to determine if the independent risk factors associated with pre and post-discharge wound complications following ALF. A P-value 0.05 was defined as significant for all statistical tests. SAS Studio Version 3.4 (SAS Institute Inc., Cary, NC, USA) was used for all statistical analysis. 7
Results 8
Conclusions Wound complications following elective ALF carry a significant impact on surgical outcomes and patient morbidity Our analysis shows that patients receiving ALF have an 8.6x risk of in-hospital or pre-discharge wound complications if they received an intraoperative osteotomy and a 9.4x risk with an intraoperative transfusion. We also identified diabetic patients undergoing ALF as being at 2.9x risk for post-discharge wound complications. Pre-discharge complications increase hospital length of stay, which has been shown to increase the risk of hospital acquired conditions and increase healthcare costs Identifying those risk factors associated with pre-discharge wound complication can allow for proper anticipation and the implementation of prophylactic measures to reduce the burden of wound complications in patients receiving elective ALF 9
Limitations The number of patients with wound complications following ALF was extremely low in this study, which limited the accuracy of the linear regression Other factors influencing complication timing may not have been captured in our model, including potential factors such as the experience of the perioperative hospital staff or the wound-care protocols employed by different hospitals. Further studies should narrow the scope of the study to assess if the timing of wound complication correlates with specific operative characteristics such as surgical incision length, location, depth etc. 10
Thank You! Khushdeep S. Vig Khushdeep.vig@mssm.edu