Sociodemographic and hospital-level predictors of muscle flap reconstruction in spinal fusion surgeries: a propensity score-matched analysis.

Abstract

Objective: Spinal fusion is associated with risks of surgical site infection and wound dehiscence. Muscle flap reconstruction during surgery may mitigate these risks. While the benefits of muscle flap reconstruction have been established, sociodemographic and hospital-level influences on access to this procedure remain unexplored. This study identifies sociodemographic predictors of muscle flap reconstruction after spinal fusion surgeries using a nationwide database.

Methods: Patients who underwent spinal fusion of two or more vertebral levels (n = 606,408) were identified from the 2012-2020 National Inpatient Sample database. The primary investigated outcome was utilization of muscle flap reconstruction. Cases without and with muscle flap reconstruction were 2:1 propensity score matched based on covariates for clinical severity and surgical complexity. Binary logistic regression identified significant sociodemographic and hospital-level predictors of receiving muscle flap reconstruction (p < 0.05).

Results: Of 606,408 discharges with spinal fusion cases, 1991 (0.3%) included muscle flap reconstruction. After matching (n = 5973), patient-level factors including private insurance status, residence in large metropolitan counties, and high median zip code income quartile, and hospital-level factors including urban teaching hospital status, higher institutional plastic surgery case volume, and private not-for-profit hospital ownership, all predicted a higher likelihood of muscle flap reconstruction (p < 0.05).

Conclusions: Multiple sociodemographic variables predict use of muscle flap reconstruction after spinal fusion surgery. These disparities may stem from multiple underlying factors, including lack of access to specialized plastic surgery care and centralization of more complex cases at quaternary care hospitals. A better understanding of these factors may help inform further efforts to increase access to muscle flap reconstruction, thereby reducing the risk of wound healing complications.