Postoperative wound complications and revisions in high-risk patients undergoing spine surgery with prophylactic muscle flap reconstruction: systematic review and meta-analysis.

Abstract

PURPOSE: Prophylactic muscle flap reconstruction (PMFR) has been explored as a preventative closure technique for patients undergoing spine surgery who are at increased risk of developing surgical site infection (SSI) and other wound-related complications. This study evaluates how PMFR may mitigate complication and revision rates in these patients. METHODS: A systematic literature search across Cochrane Central Register of Controlled Trials (Central), Embase, Medline, Scopus, and Web of Science was conducted from inception through July 2024 to identify all comparative studies utilizing PMFR for closure after spine surgery. Random-effects model meta-analysis was performed assessing wound complications and revisions required, and the Newcastle-Ottawa Quality Assessment Scale for observational studies was used to assess the quality. RESULTS: Six studies (n = 1,475) comparing PMFR to conventional closure were included in this study. Of which, 515 patients underwent PMFR, while 960 patients did not undergo PMFR. The mean age at surgery was 59.4 ± 15.3 in the PMFR group and 60 ± 18.6 in the non-PMFR group. The mean operative time (MD: -95.06, 95%CI -178.08 to -12.04, p = 0.02) and the mean length of stay (MD: -3.06, 95%CI -4.99 to -1.14, p < 0.01) were significantly shorter in the non-PMFR group compared to the PMFR group. Neither SSI (OR 0.72, 95%CI 0.31 to 1.67, p = 0.36) nor wound dehiscence (OR 0.54, 95%CI 0.06 to 4.96, p = 0.35) were significantly different between the PMFR and non-PMFR groups. Revisions due to wound complications (OR 0.85, 95%CI: 0.24 to 2.95, p = 0.73) and overall revisions (OR 1.68, 95%CI: 0.64 to 4.38, p = 0.23) did not significantly differ between groups. CONCLUSION: This meta-analysis of six studies did not show any significant differences in perioperative wound complication or revision rates among patients who underwent spine surgery with or without PMFR, despite patients in the PMFR presenting with significantly more risks for wound complications. Given the increased operative time and length of stay associated with the PMFR group, PMFR should be selectively implemented based on individual patient risk profiles.