BACKGROUND CONTEXT

Unplanned reoperation, a quality indicator in spine surgery, has not been sufficiently investigated in a large-scale, single-center study.

PURPOSE

To assess the incidences, causes, and risk factors of unplanned reoperations within 30 days of spine surgeries in a single-center study.

STUDY DESIGN

Retrospective observational study.

PATIENT SAMPLE

A cohort of 35,246 patients who underwent spinal surgery in our hospital were included.

OUTCOME MEASURES

The rates, chief reasons, and risk factors for unplanned reoperations within 30 days of spine surgery.

METHODS

We retrospectively analyzed the data for patients who underwent spine surgeries for degenerative spinal disorders, tumor, or deformity and had subsequent unplanned operations within 30 days at a single tertiary academic hospital from January 2016 to July 2021. Univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors.

RESULTS

Out of 35,246 spinal surgery patients, 297 (0.84%) required unplanned reoperations within 30 days of spine surgery. Patients with a thoracic degenerative disease (3.23%), spinal tumor (1.63%), and spinal deformity (1.50%) had significantly higher rates of reoperation than those with atlantoaxial (0.61%), cervical (0.65%), and lumbar (0.82%) degenerative disease. The common causes for reoperation included epidural hematoma (0.403%), wound infections (0.148%), neurological deficit (0.108%), and pedicle screw malposition (0.077%). Unplanned reoperations were classified as hyperacute (45.45%), acute (30.98%), subacute (15.82%), or chronic (7.74%). Univariate analysis indicated that 20 clinical factors were associated with unplanned reoperation (p<.05). Multivariate Poisson regression analysis revealed that anemia (p<.001), osteoporosis (p=.048), ankylosing spondylitis (p=.008), preoperative foot drop (p=.011), deep venous thrombosis (p<.001), and previous surgical history (p<.001) were independent risk factors for unplanned spinal reoperation.

CONCLUSIONS

The incidence of unplanned spinal reoperations was 0.84%. The chief common causes were epidural hematoma, wound infections, neurological deficit, and pedicle screw malposition. Anemia, osteoporosis, ankylosing spondylitis, preoperative foot drop, deep venous thrombosis, and previous surgical history led to an increased risk of unplanned reoperation within 30 days of spine surgery.

中文翻译：

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脊柱手术后 30 天内计划外再次手术的发生率、原因和危险因素：一项基于 35,246 名患者的单中心研究

背景语境

计划外再次手术是脊柱手术的质量指标，但尚未在大规模、单中心研究中得到充分研究。

目的

在一项单中心研究中评估脊柱手术后 30 天内计划外再次手术的发生率、原因和风险因素。

学习规划

回顾性观察研究。

患者样本

纳入了在我们医院接受脊柱手术的 35,246 名患者队列。

结果测量

脊柱手术后 30 天内计划外再次手术的发生率、主要原因和风险因素。

方法

我们回顾性分析了 2016 年 1 月至 2021 年 7 月期间在一家三级学术医院接受脊柱退行性疾病、肿瘤或畸形手术并随后在 30 天内进行计划外手术的患者的数据。进行了单变量和多变量分析以评估发生率、原因和危险因素。

结果

在 35,246 名脊柱手术患者中，297 名 (0.84%) 需要在脊柱手术后 30 天内进行计划外再次手术。胸部退行性疾病（3.23%）、脊柱肿瘤（1.63%）和脊柱畸形（1.50%）患者的再次手术率显着高于寰枢椎（0.61%）、颈椎（0.65%）和腰椎（0.82）患者%) 退行性疾病。再次手术的常见原因包括硬膜外血肿（0.403%）、伤口感染（0.148%）、神经功能缺损（0.108%）和椎弓根螺钉错位（0.077%）。计划外再次手术分为超急性 (45.45%)、急性 (30.98%)、亚急性 (15.82%) 或慢性 (7.74%)。单变量分析表明，20 个临床因素与计划外再次手术相关（p <.05). 多变量泊松回归分析显示贫血 (p<.001)、骨质疏松症 (p=.048)、强直性脊柱炎 (p=.008)、术前足下垂 (p=.011)、深静脉血栓形成 (p<.001)和既往手术史 (p<.001) 是计划外脊柱再次手术的独立危险因素。

结论

计划外脊柱再手术的发生率为 0.84%。主要的常见原因是硬膜外血肿、伤口感染、神经功能缺损和椎弓根螺钉错位。贫血、骨质疏松症、强直性脊柱炎、术前足下垂、深静脉血栓形成和既往手术史导致脊柱手术后 30 天内意外再次手术的风险增加。