Abstract
Purpose
To investigate the incidence and causes of reoperations within 30 days of spine surgery.
Methods
Patients who underwent spine surgery between 2002 and 2012, at one of 9 institutions, were enrolled. The causes of all reoperations, within 30 days of the index surgery, were reviewed. The incidence of reoperations within 30 days were calculated and compared according to the preoperative diagnosis, use of instrumentation, surgical level, and approach. Moreover, the distribution of the causes for reoperations within the 30-day period was also assessed.
Results
The overall incidence of reoperations, within 30 days of spine surgery, was 1.6 % (175/10,680). Patients who underwent instrumentation procedures demonstrated a higher incidence of reoperations than patients who underwent procedures without instrumentation (P < 0.001). Moreover, patients diagnosed with preoperative trauma had a higher incidence of reoperation than those with other diagnoses (P < 0.001). Surgical site infection (SSI), postoperative epidural hematoma, pedicle screw malposition, and inadequate decompression were the four main causes of reoperation. Motor paralysis, due to epidural hematoma, was the predominant cause of reoperations during the hyper-acute phase (0–1 days, postoperatively), whereas SSI was the dominant cause during the sub-acute phase (11–30 days, postoperatively).
Conclusions
This large, multi-center study indicated the causes and incidence of reoperations, within 30 days of the initial spinal surgery. Based on these data, spinal surgeons can provide patients with information that allows them to better understand the surgical risk and expected post-surgical management.
Similar content being viewed by others
References
Pichelmann MA, Lenke LG, Bridwell KH, Good CR, O’Leary PT, Sides BA (2010) Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine 35:219–226. doi:10.1097/BRS.0b013e3181c91180
Jansson KA, Nemeth G, Granath F, Blomqvist P (2005) Spinal stenosis re-operation rate in Sweden is 11% at 10 years–a national analysis of 9664 operations. Eur Spine J 14:659–663. doi:10.1007/s00586-004-0851-9
Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA (2007) Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine 32:382–387. doi:10.1097/01.brs.0000254104.55716.46
Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine 31:2329–2336. doi:10.1097/01.brs.0000238968.82799.d9
Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA (2007) Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine 32:2119–2126. doi:10.1097/BRS.0b013e318145a56a
Martin CT, Pugely AJ, Gao Y, Ilgenfritz RM, Weinstein SL (2014) Incidence and risk factors for early wound complications after spinal arthrodesis in children: analysis of 30-day follow-up data from the ACS-NSQIP. Spine 39:1463–1470. doi:10.1097/BRS.0000000000000446
Abdul-Jabbar A, Berven SH, Hu SS, Chou D, Mummaneni PV, Takemoto S, Ames C, Deviren V, Tay B, Weinstein P, Burch S, Liu C (2013) Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 38:E1425–E1431. doi:10.1097/BRS.0b013e3182a42a68
Lovecchio F, Hsu WK, Smith TR, Cybulski G, Kim B, Kim JY (2014) Predictors of thirty-day readmission after anterior cervical fusion. Spine 39:127–133. doi:10.1097/BRS.0000000000000051
McCormack RA, Hunter T, Ramos N, Michels R, Hutzler L, Bosco JA (2012) An analysis of causes of readmission after spine surgery. Spine 37:1260–1266. doi:10.1097/BRS.0b013e318245f561
Wang MC, Shivakoti M, Sparapani RA, Guo C, Laud PW, Nattinger AB (2012) Thirty-day readmissions after elective spine surgery for degenerative conditions among US Medicare beneficiaries. Spine J 12:902–911. doi:10.1016/j.spinee.2012.09.051
Martin CT, Pugely AJ, Gao Y, Weinstein SL (2015) Causes and risk factors for 30-day unplanned readmissions after pediatric spinal deformity surgery. Spine 40:238–246. doi:10.1097/BRS.0000000000000730
Kadono Y, Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S, Tanaka S, Nakamura K (2010) Statistics for orthopedic surgery 2006-2007: data from the Japanese Diagnosis Procedure Combination database. J Orthopc Sci 15:162–170. doi:10.1007/s00776-009-1448-2
Schairer WW, Carrer A, Deviren V, Hu SS, Takemoto S, Mummaneni P, Chou D, Ames C, Burch S, Tay B, Sawyer A, Berven SH (2013) Hospital Readmission After Spine Fusion for Adult Spinal Deformity. Spine (Phila Pa 1976). doi:10.1097/BRS.0b013e31829c08c9
Petty W, Spanier S, Shuster JJ, Silverthorne C (1985) The influence of skeletal implants on incidence of infection. Experiments in a canine model. J Bone Joint Surg Am 67:1236–1244
Gristina AG (1994) Implant failure and the immuno-incompetent fibro-inflammatory zone. Clin Orthop Relat Res (298):106–118
An YH, Friedman RJ (1998) Concise review of mechanisms of bacterial adhesion to biomaterial surfaces. J Biomed Mater Res 43:338–348
Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM (2001) Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma 15:566–569
O’Neill KR, Smith JG, Abtahi AM, Archer KR, Spengler DM, McGirt MJ, Devin CJ (2011) Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J 11:641–646. doi:10.1016/j.spinee.2011.04.025
Sweet FA, Roh M, Sliva C (2011) Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine 36:2084–2088. doi:10.1097/BRS.0b013e3181ff2cb1
Shamji MF, Cook C, Pietrobon R, Tackett S, Brown C, Isaacs RE (2009) Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis. Spine J 9:31–38. doi:10.1016/j.spinee.2008.07.005
Levi AD, Dickman CA, Sonntag VK (1997) Management of postoperative infections after spinal instrumentation. J Neurosurg 86:975–980. doi:10.3171/jns.1997.86.6.0975
Mok JM, Guillaume TJ, Talu U, Berven SH, Deviren V, Kroeber M, Bradford DS, Hu SS (2009) Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine 34:578–583. doi:10.1097/BRS.0b013e31819a827c
Dommisse GF (1974) The blood supply of the spinal cord. A critical vascular zone in spinal surgery. J Bone Joint Surg Br 56:225–235
Cramer DE, Maher PC, Pettigrew DB, Ct Kuntz (2009) Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution. J Spinal Disord Tech 22:565–570. doi:10.1097/BSD.0b013e318193452a
Aono H, Ohwada T, Hosono N, Tobimatsu H, Ariga K, Fuji T, Iwasaki M (2011) Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine 15:202–205. doi:10.3171/2011.3.SPINE10716
Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2006) Delayed postoperative spinal epidural hematoma causing tetraplegia. Case report. J Neurosurg Spine 5:251–253. doi:10.3171/spi.2006.5.3.251
Sokolowski MJ, Dolan M, Aminian A, Haak MH, Schafer MF (2006) Delayed epidural hematoma after spinal surgery: a report of 4 cases. J Spinal Disord Tech 19:603–606. doi:10.1097/01.bsd.0000211242.44706.62
Wada E, Yonenobu K, Ebara S, Kuwahara O, Ono K (1993) Epidural migration of hemostatic agents as a cause of postthoracotomy paraplegia. Report of two cases. J Neurosurg 78:658–660. doi:10.3171/jns.1993.78.4.0658
Buchowski JM, Bridwell KH, Lenke LG, Good CR (2009) Epidural spinal cord compression with neurologic deficit associated with intrapedicular application of hemostatic gelatin matrix during pedicle screw insertion. Spine 34:E473–E477. doi:10.1097/BRS.0b013e3181a56a21
Kao FC, Tsai TT, Chen LH, Lai PL, Fu TS, Niu CC, Ho NY, Chen WJ, Chang CJ (2015) Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J 24:348–357. doi:10.1007/s00586-014-3297-8
Khazim R, Dannawi Z, Spacey K, Khazim M, Lennon S, Reda A, Zaidan A (2015) Incidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery. Eur Spine J. doi:10.1007/s00586-015-3830-4
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Shimizu, T., Fujibayashi, S., Takemoto, M. et al. A multi-center study of reoperations within 30 days of spine surgery. Eur Spine J 25, 828–835 (2016). https://doi.org/10.1007/s00586-015-4113-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-4113-9