Plastic Surgery-Assisted Closure of Complex Posterior Spine Surgery Wounds Are Associated with Rate of Readmission and Reimbursement

Author(s): Sarah M. Trent MD, Alexandra Echevarria BS, Ariel N. Rodriguez MD, Robert Carrier DO, Austen Katz MD, Sohrab Virk MD, Afshin Razi MD, David Essig

Objective:

The objective of this study is to compare clinical outcomes and reimbursements between plastic surgeon (PS) and spine surgeon (SS) closure of wounds following complex posterior spine reconstruction surgery.

Methods:

Data was sourced from the PearlDiver Mariner Administrative claims database. The patient cohorts included those who underwent posterior spinal fusion with at least 7 levels fused. Several 30-day postoperative outcomes were examined, including readmission rates, sepsis, myocardial infarction, pneumonia, cerebrovascular accident, deep vein thrombosis, pulmonary embolism, venous thromboembolism, surgical site infections (SSI), and emergency department visits. Mean 30- day reimbursement costs were also analyzed. Statistical analysis involved Chi-square testing for categorical variables and T-tests for continuous variables. Multivariate logistic regression was employed to calculate odds ratios and 95% confidence intervals. Statistical significance was defined as a p-value of less than 0.05.

Results:

The demographics of the matched cohorts indicated no significant differences in age, gender and Elixhauser Comorbidity Index. The readmission rate for the PS group was 19.6%, compared to 12.1% for the SS group (OR = 1.74, CI 1.35-2.22, p < 0.001). Mean 30-day reimbursement was lower for the PS group at $24,072.94 compared to $31,204.64 in the SS group (p < 0.0001). No significant differences were observed in other 30-day outcomes.

Conclusion:

No significant difference in the rate of SSI was demonstrated between the two closure teams. However, we found that PS closure correlates with an increased rate of 30-day readmission and decreased reimbursement.