Introduction: Posterior cervical fusion (PCF) is a common surgical procedure with growing utilization and good long-term outcomes reported. Wound complications can be catastrophic and consistent risk factors have not been identified using a large nationwide database. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) provides a large multicenter database and allows for the analysis of potential risk factors.
Methods: This was a retrospective analysis of prospectively collected data from the NSQIP database. Patients > 18 years old undergoing PCF between 2005 and 2012 were included. Patient baseline factors, perioperative data, preoperative labs, American Society of Anesthesiologists (ASA) scores and post-operative events were recorded. Patients in the two cohorts were compared using multivariate logistic regression analysis with significance defined as p < 0.05. Odds ratio (OR) was calculated with a 95% confidence interval (CI).
Results: 524 patients met inclusion criteria with incidence of any wound complication (3.2%), superficial infection (1.5%), deep infection (1.0%), wound dehiscence (0.6%) and organ space infection (0.6%). Higher rates of wound complications occurred in patients with ASA >/= 3 (p=0.04). Other patient comorbidities, operative variables and lab values were not significant risk factors for wound complications (p>0.05). Patients with postoperative wound complications had higher reoperation rates
Conclusions: Higher rates of wound complications were associated with higher ASA class though other comorbidities and prolonged operative time were not significant. As expected higher reoperation rates and readmissions were associated with patients developing wound complications. These factors should be considered during perioperative care in patients undergoing elective PCF.
Patient Care: Understand what drives the variations patient outcomes, such as wound complications and reoperation rates, is an important step toward providing higher quality care.
Learning Objectives: Our objective was to analyze risk factors for wound complications following PCF and associated complications, mortality, reoperation rates and post-operative events within 30 days.