D83. Watching Your Back: The Effect of Muscle Flap Coverage on Outcomes and Resource Utilization following Posterior Spinal Fusions

Abstract

PURPOSE: Rates of spinal degenerative deformities and spondylosis have a prevalence of over 60% in elderly patients. An estimated $34 billion is spent annually on posterior spinal fusions (PSFs) and subsequent postoperative complications, which affect upwards of 20% of patients. Wound closure involving local muscle flaps has been associated with reduced rates of complications compared to primary closure. The rise in PSF rates and health expenditures underscores the need for healthcare utilization studies to inform decision-makers on best operative protocols. METHODS: A retrospective review was performed on adult patients who underwent PSF due to degenerative deformity or spondylosis. Health and economic outcomes were compared between PSF procedures with local muscle flap closure vs. primary closure. Patient-level costs were calculated using standard unit cost estimates derived from CMS Medicare fee schedules. RESULTS: 200 patients met our study criteria; 100 received prophylactic muscle flap closure by plastic surgery. The groups did not differ significantly in terms of gender, race, insurance status, surgical indication, or number of vertebrae fused. Patients who received muscle flaps had significantly fewer post-operative infections and readmissions, and more seromas. Use of muscle flaps did not increase operative time, length of stay, or outpatient resource utilization. Reductions in postoperative resource utilization without statistically significant increases in peri-operative costs resulted in an average cost reduction of $2,760 per patient. CONCLUSION: In this study, those who received muscle flap closure had fewer complications without the burden of increased resource utilization, providing useful information for stakeholders when deciding to implement this technique.