Comparative study of 2-Octylcyanoacrylate plus polymer mesh tape and surgical stapler for preventing surgical site infection following corrective fusion in patients with adult spinal deformity: a retrospective cohort study.

Abstract

<h4>Background</h4>The risk of surgical site infection (SSI) is high following extensive spinal fusion procedures, especially those involving instrumentation and prolonged operative time. This retrospective cohort study aimed to investigate the efficacy of using a 2-octylcyanoacrylate adhesive with a self-adhesive polymer mesh tape (2OPMT) for preventing SSI after long-segment corrective fusion in adult spinal deformity (ASD) patients.<h4>Methods</h4>We retrospectively analyzed 488 ASD patients (401 females; mean age 61.8 years) who underwent posterior corrective fusion of ≥ 5 vertebrae at a single center between 2010 and 2021, with minimum 1-year follow-up. From 2010 to 2015, wounds were closed with subcuticular sutures plus skin staples (stapler group, n = 267). From 2015 onward, wounds were closed with subcuticular continuous sutures plus the 2OPMT system (2OPMT group, n = 221). We compared the incidence of SSIs between groups. Independent risk factors for SSI were assessed by univariate analysis. Propensity score matching (1:1 nearest-neighbor, caliper 0.2, no replacement) was performed using age, body mass index (BMI), number of fused vertebrae, operative time, and American Society of Anesthesiologists (ASA) class.<h4>Results</h4>In the full cohort, the overall incidence of SSI was 6.4% in the stapler group vs. 2.7% in the 2OPMT group (P = 0.058). The 2OPMT group had a significantly lower rate of deep SSI compared to the stapler group (1.4% vs. 4.5%, P = 0.046), while superficial SSI rates were similar (1.4% vs. 1.9%, P = 0.470). Univariate comparisons showed the stapler group had a higher mean age (63.4 vs. 59.8 years, P = 0.033) and longer operative time (381 vs. 351 min, P = 0.002) than the 2OPMT group. After propensity score matching (162 patients in each group, with baseline characteristics balanced including ASA class distribution, standardized mean difference ≈ 0.00), the overall SSI rate remained significantly lower in the 2OPMT group (2.5%) than in the stapler group (7.4%, P = 0.043; odds ratio [OR] 0.32, 95% confidence interval [CI] 0.10-0.99). The deep SSI rate in the matched cohort was also lower with 2OPMT (1.5% vs. 5.4%, P = 0.030; OR 0.29, 95% CI 0.07-1.19), whereas superficial SSI rates were low and not significantly different (1.5% vs. 2.5%, P = 0.475).<h4>Conclusions</h4>Wound closure using 2OPMT in long-segment ASD fusion surgery was associated with a lower incidence of postoperative wound infections compared to conventional skin staples. The propensity-matched analysis accounting for patient comorbidities (including ASA class) further supports a beneficial effect of 2OPMT on reducing SSIs. These findings indicate that 2OPMT provides a reliable wound sealant that may enhance healing and reduce infection risk in complex spinal surgeries.