OBJECTIVES: To compare economic and clinical outcomes of spinal fusion surgery with skin closure through skin staples plus waterproof wound dressings (SSWWD) versus 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT).

METHODS: Retrospective observational study using data from the Premier Healthcare Database. Studied patients were aged ≥18 years who underwent elective inpatient spinal fusion surgery for a spine disorder (scoliosis, spondylolysis, , spinal stenosis, or intervertebral disc disease) between 1-October-2015—31-March-2019 (first=index surgery). Hospital administrative billing records were used to classify patients into two mutually-exclusive groups based on use of SSWWD or 2OPMT during the index surgery. Outcomes included total costs from the hospital perspective, operating room time (ORT), hospital length of stay (LOS), nonhome discharge, infection/wound complications during the 90-day global period (index surgery through 90 days post-discharge), and 30/60/90-day all-cause readmissions. We compared outcomes between study groups using a combination of nearest neighbor propensity score matching with exact matching on 45 primary procedure/diagnosis code groupings and generalized estimating equations to account for hospital-level clustering.

RESULTS: A total of 11,991 patients met the study criteria (2OPMT=5,961; SSWWD=6,030), of which 3,602 were included in each post-match study comparison group (total=7,204); all variables were balanced (standardized mean difference<0.10) after matching. As compared with the SSWWD group, the 2OPMT group had a lower median ORT (240 vs. 270 minutes; p=0.0207) and mean LOS (3.4 [SD=2.6] vs. 3.9 [SD=2.8] days; p=0.0223); and lower incidence proportions of nonhome discharge status (17.6% vs. 23.1%; p=0.0290), overall infections/wound complications (1.69% vs. 2.83%; p=0.0266), and surgical site infection (1.11% vs. 2.20%; p=0.0128). Differences between groups in other outcomes were statistically insignificant (p>0.05).

CONCLUSIONS: In this retrospective observational study of patients undergoing spinal fusion surgery, the use of 2OPMT for skin closure was associated with significantly lower ORT, LOS, nonhome discharge, and 90-day rates of infections/wound complications as compared with SSWWD.