Incidences, causes and risk factors of unplanned reoperations within 30 days of spine surgery: a single-center study based on 35,246 patients

Ouyang, Hanqiang; Hu, Yuanyu; Hu, Wenshuang; Zhang, Hua; Sun, Zhuoran; Tang, Yanchao; Yu, Junsheng; Chen, Jianming; Dong, Shu; Li, Weishi; Tian, Yun

doi:10.1016/j.spinee.2022.07.098

Cited by 3 publications

(8 citation statements)

References 26 publications

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“…Most patients with cerebrospinal fluid leakage recovered after conservative treatment, except for two patients with poor wound healing and one with a secondary surgical site infection. A total of seven patients (4.6%) required unplanned reoperation, which is also consistent with the revision rate of 3.3% to 4.0% reported previously 14,31 . There were three cases of transient neurological deterioration, all of which were recovered with conservative therapy.…”

Section: Discussionsupporting

confidence: 86%

Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum

Dong

et al. 2023

Orthopaedic Surgery

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ObjectiveDespite rapid advances in minimally invasive surgery, en bloc laminectomy remains the most common surgical approach for treating thoracic ossification of the ligamentum flavum (TOLF). However, the learning curve of this risky operation is rarely reported. Therefore, we aimed to describe and analyze the learning curve of ultrasonic osteotome‐based en bloc laminectomy for TOLF.MethodsAmong 151 consecutive patients with TOLF who underwent en bloc laminectomy performed by one surgeon between January 2012 and December 2017, we retrospectively analyzed their demographic data, surgical parameters, and neurological function. Neurological outcome was evaluated with the modified Japanese Orthopaedic Association (mJOA) scale, and the Hirabayashi method was used to calculate the neurological recovery rate. The learning curve was assessed with logarithmic curve‐fitting regression analysis. Univariate analysis methods were used for statistical analysis, including t‐test, rank sum test, and chi‐square test.ResultsA total of 50% of learning milestones could be reached in approximately 14 cases, and the asymptote in 76 cases. Therefore, 76 of the 151 enrolled patients were defined as the “early group,” and the remaining 75 were delimitated as the “late group” for comparison. There was a significant intergroup difference in the corrected operative time (94.80 ± 27.77 vs 65.93 ± 15.67 min, P < 0.001) and the estimated blood loss (median 240 vs 400 mL, P < 0.001). The overall follow‐up was 83.1 ± 18.5 months. The mJOA significantly increased from a median of 5 (IQR: 4–5) before the surgery to 10 (IQR: 9–10) at the last follow‐up (P < 0.001). The overall complication rate was 37.1%, and no significant intergroup difference was found, except for the incidence of dural tears (31.6% vs 17.3%, p = 0.042).ConclusionInitially, mastering the en bloc laminectomy technique using ultrasonic osteotome for TOLF treatment can be challenging, but the surgeon's experience improves as the operative time and blood loss decrease. Improved surgical experience reduced the risk of dural tears but was not associated with the overall complication rate or long‐term neurological function. Despite the relatively long learning curve, en bloc laminectomy is a secure and valid technique for TOLF treatment.

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Section: Discussionsupporting

confidence: 86%

Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum

Dong

et al. 2023

Orthopaedic Surgery

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“…Another recent report included a large-scale analysis of unplanned reoperation following spine surgery based on data of 35,246 patients, 929 of whom underwent thoracic surgery. 2 The 30-day reoperation rates for spine surgery and thoracic surgery were 0.84% and 3.23%, respectively. However, the causes and risk factors for reoperation of thoracic spine surgery were not investigated in these two administrative database studies which included surgeries of all regions of the spine, hence being less useful for other orthopedists.…”

Section: Discussionmentioning

confidence: 94%

“…According to the study by Kerezoudis et al ,12 the reoperation rates for thoracic fusion and thoracic decompression were 6.9% and 5.6%, respectively. Another recent report included a large-scale analysis of unplanned reoperation following spine surgery based on data of 35,246 patients, 929 of whom underwent thoracic surgery 2. The 30-day reoperation rates for spine surgery and thoracic surgery were 0.84% and 3.23%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 Only two studies reported the incidence of unplanned reoperations after thoracic spine surgery, determined to be 5.6% and 3.23%. 2 , 12 However, both were administrative database studies including various surgeries of all regions of the spine, which limited their usefulness. Besides, neither of these studies analyzed the causes and risk factors for unanticipated reoperations of thoracic spine surgery.…”

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confidence: 99%

“…For surgery of all regions of the spine, the reoperation rates reported in the literature range from 0.84% to 5.47%, depending on the patient population and follow-up period 2–5. Other studies focused on unplanned reoperations of the cervical spine, lumbar spine, spinal deformities, and spinal tumors, recording reoperation incidence rates up to 2.6%, 4.3%, 4.8%, and 8.18%, respectively 6–9.…”

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confidence: 99%

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Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-Center Study Based on 1948 Patients

Ouyang

Yang

et al. 2022

Spine

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Study Design. A retrospective study. Objective. The purpose of this study is to identify the incidences, causes, and risk factors of 30-day unplanned reoperation of posterior surgery for thoracic spinal stenosis (TSS) based on 1948 patients in a single center. Summary of Background Data. Unplanned reoperation is suggested to be a useful quality indicator for spine surgery. However, the incidences, causes, and risk factors of 30-day unplanned reoperation in patients who underwent posterior spinal surgery for TSS have not been well-established. Materials and Methods. We retrospectively analyzed the clinical data of patients who underwent posterior spinal surgery for TSS from January 2011 to December 2021. Statistical methods including univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors. Results. A total of 1948 patients who underwent posterior spinal surgery for TSS in our institution were reviewed, and 77 (3.95%) required unplanned reoperations within 30 days because of epidural hematoma (1.64%), wound-related complications (1.02%), inadequate decompression (0.41%), and implant malposition or failure (0.36%), neurological deficit (0.26%), and other causes (0.26%). After univariate analysis, seven clinical factors were associated with unplanned reoperation (P<0.05). Multivariate logistic regression analysis showed that upper thoracic spine surgery (P=0.010), thoracic kyphosis ≥45° (P=0.039), and intraoperative dural injury (P=0.047) were independent risk factors for 30-day unplanned reoperation of posterior surgery for TSS. Conclusions. The incidence of 30-day unplanned reoperations after posterior surgical treatment for TSS was 3.95%. The most common causes were epidural hematoma, wound-related complications, inadequate decompression, and implant malposition or failure. Upper thoracic spine surgery, thoracic kyphosis ≥45°, and intraoperative dural injury led to an increased risk of unplanned reoperation within 30 days after posterior spinal surgery for TSS. Level of Evidence. 4.

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Thirty-day unplanned reoperations of thoracic spine surgery: 10 years of data from a single center with 3242 patients

Ouyang

Yang

et al. 2023

The Spine Journal

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Incidences, causes and risk factors of unplanned reoperations within 30 days of spine surgery: a single-center study based on 35,246 patients

Cited by 3 publications

References 26 publications

Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum

Learning Curve and Clinical Outcomes of Ultrasonic Osteotome‐based En Bloc Laminectomy for Thoracic Ossification of the Ligamentum Flavum

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-Center Study Based on 1948 Patients

Thirty-day unplanned reoperations of thoracic spine surgery: 10 years of data from a single center with 3242 patients

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