The National Surgical Quality Improvement Program conducted a retrospective cohort analysis. For a study, researchers sought to determine which preoperative factors influence the choice to undertake preventive muscle flap closure and assess risk factors for wound healing issues in patients undergoing spinal operations with and without muscle flap closure. The National Surgical Quality Improvement Program database was searched for all patients who had spine surgery with or without concurrent muscle flaps between 2005 and 2017. Variables from the preoperative and postoperative periods were gathered. To determine which preoperative factors enhanced the likelihood of patients having flap closures a priori, investigators used univariate and multivariate analyses to analyze risk factors impacting surgical site infection (SSI) and wound disruption. Concurrent muscle flaps were performed on 758 individuals, while 301,670 patients received no flap. Overall, 29 patients (3.83%) in the flap group had SSI, compared to 5,154 individuals (1.71%) in the non flap group (P<0.0001). The use of muscle flaps was strongly linked with preoperative steroid use [odds ratio (OR) 0.5; P<0.0001], wound infection (OR 0.24; P<0.0001), high white blood cell count (OR 1.034; P<0.0001), poor hematocrit (OR 0.94; P<0.0001), and preoperative transfusion (OR 0.22; P=0.0068). Postoperative wound disruption was strongly linked with a polluted wound (OR 4.72; P<0.0001), the American Society of Anesthesiologists’ categorization of severe disease (OR 1.92; P=0.024), and longer operating time (OR 1.001; P=0.0024). Furthermore, there was no difference in the rates of SSI between the flap and non flap groups following propensity score matching for these characteristics that enhance the risk of wound complications. The outcomes implied that patients with a higher preoperative illness burden were more likely to obtain preventive paraspinal flaps, which could lower wound-related problems rates.