Indications for and outcomes of muscle flap reconstruction after pediatric posterior spinal fusion: An ACS-NSQIP analysis of 32,466 surgeries.

Abstract

Muscle flap reconstruction immediately after pediatric spinal fusion surgeries has been associated with favorable post-operative outcomes. This study employed a database with large geographic coverage to further characterize indications for and outcomes of such reconstructions. Overall, 32,466 posterior spinal fusion cases from 2016 to 2022 were identified within the ACS-NSQIP Pediatric (NSQIP-P) database. Multivariable logistic regression was used to identify variables independently associated with the outcomes of flap reconstruction. Efficacy of muscle flap reconstruction was assessed using a training set, validation set without flap reconstruction, and test set with flap reconstruction, followed by difference-in-differences analysis between the validation and test sets (p<0.05). Muscle flap reconstruction occurred in 3.0% of the cases with the rate increasing from 1.7% in 2016 to 4.4% in 2022. When compared to idiopathic spinal deformity, neuromuscular (OR: 1.56, 95% CI: 1.27-1.91) classification was associated with an increased likelihood of flap reconstruction. Moreover, 13+ instrumented levels (OR: 2.41, 95% CI: 1.84-3.14), prior spine surgery (OR: 2.48, 95% CI: 2.08-2.97), and American Society of Anesthesiologists class >2 (OR: 1.47, 95% CI: 1.24-1.75) also increased the likelihood of flap reconstruction. Flap reconstruction was associated with a lower rate of post-operative complications than the expected rate calculated in a cohort that did not use such reconstruction (p<0.001). Muscle flap reconstruction in pediatric spinal fusion cases has increased more than twofold in prevalence and occurs in cases with higher surgical complexity and risk. Flap reconstruction is independently associated with a lower rate of post-operative complications than expected.