BACKGROUND CONTEXT

Reoperation following cervical spinal surgery negatively impacts patient outcomes and increases health care system burden. To date, most studies have evaluated reoperations within 30 days after spine surgery and have been limited in scope and focus. Evaluation within the 90-day period, however, allows a more comprehensive assessment of factors associated with reoperation.

PURPOSE

The purpose of this study is to assess the rates and reasons for reoperations after cervical spine surgery within 30 and 90 days.

DESIGN

We performed a retrospective analysis of a state-wide prospective, multi-center, spine-specific database of patients surgically treated for degenerative disease.

PATIENT SAMPLE

Patients 18 years of age or older who underwent cervical spine surgery for degenerative pathologies from February 2014 to May 2019. Operative criteria included all degenerative cervical spine procedures, including those with cervical fusions with contiguous extension down to T3.

OUTCOME MEASURES

We determined causes for reoperation and independent surgical and demographic risk factors impacting reoperation.

METHODS

Patient-specific and surgery-specific data was extracted from the registry using ICD-10-DM codes. Reoperations data was obtained through abstraction of medical records through 90 days. Univariate analysis was done using chi-square tests for categorical variables, t-tests for normally distributed variables, and Wilcoxon rank-sum tests for variables with skewed distributions. Odds ratios for return to the operating room (OR) were evaluated in multivariate analysis.

RESULTS

A total of 13,435 and 13,440 patients underwent cervical spine surgery and were included in the 30 and 90-day analysis, respectively. The overall reoperation rate was 1.24% and 3.30% within 30 and 90 days, respectively. Multivariate analysis showed within 30 days, procedures involving four or more levels, posterior only approach, and longer length of stay had increased odds of returning to the OR (p<.05), whereas private insurance had a decreased odds of return to OR (p<.05). Within 90 days, male sex, coronary artery disease (CAD), previous spine surgery, procedures with 4 or more levels, and longer length of stay had significantly increased odds of returning to the OR (p<.05). Non-white race, independent ambulatory status pre-operatively, and having private insurance had decreased odds of return to the OR (p<.05). The most common specified reasons for return to the OR within 30 days was hematoma (19%), infection (17%), and wound dehiscence (11%). Within 90 days, reoperation reasons were pain (10%), infection (9%), and hematoma (8%).

CONCLUSION

Reoperation rates after elective cervical spine surgery are 1.24% and 3.30% within 30 and 90 days, respectively. Within 30 days, four or more levels, posterior approach, and longer length of stay were risk factors for reoperation. Within 90 days, male sex, CAD, four or more levels, and longer length of hospital stay were risk factors for reoperation. Non-white demographic and independent preoperative ambulatory status were associated with decreased reoperation rates.

中文翻译：

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颈椎手术后 30 天和 90 天内再次手术的比率和原因：密歇根脊柱手术改进协作 (MSSIC) 注册的回顾性队列分析

背景语境

颈椎手术后的再次手术会对患者的预后产生负面影响，并增加医疗保健系统的负担。迄今为止，大多数研究都评估了脊柱手术后 30 天内的再次手术，并且范围和重点有限。然而，90 天内的评估可以更全面地评估与再手术相关的因素。

目的

本研究的目的是评估颈椎手术后 30 天和 90 天内再次手术的发生率和原因。

设计

我们对全州前瞻性、多中心、脊柱特异性数据库进行了一项回顾性分析，该数据库包含接受手术治疗的退行性疾病患者。

患者样本

2014 年 2 月至 2019 年 5 月因退行性病变接受颈椎手术的 18 岁或以上患者。手术标准包括所有退行性颈椎手术，包括颈椎融合且连续延伸至 T3 的手术。

结果测量

我们确定了再次手术的原因以及影响再次手术的独立手术和人口统计学风险因素。

方法

使用 ICD-10-DM 代码从注册表中提取特定于患者和特定于手术的数据。通过提取 90 天的医疗记录获得再手术数据。使用分类变量的卡方检验、正态分布变量的 t 检验和偏态分布变量的 Wilcoxon 秩和检验进行单变量分析。在多变量分析中评估返回手术室 (OR) 的比值比。

结果

共有 13,435 名和 13,440 名患者接受了颈椎手术，分别被纳入 30 天和 90 天的分析。30天和90天的总体再手术率分别为1.24%和3.30%。多变量分析显示，在 30 天内，涉及四个或更多节段、仅后路入路和较长住院时间的手术增加了返回手术室的几率 (p<.05)，而私人保险则降低了返回手术室的几率 ( p<.05)。在 90 天内，男性、冠状动脉疾病 (CAD)、既往脊柱手术史、4 级或更多级别的手术以及更长的住院时间显着增加了返回 OR 的几率 (p<.05)。非白种人、术前独立走动状态和拥有私人保险降低了返回手术室的几率 (p<.05)。伤口裂开 (11%)。90 天内，再次手术的原因是疼痛（10%）、感染（9%）和血肿（8%）。

结论

择期颈椎手术后 30 天和 90 天的再手术率分别为 1.24% 和 3.30%。30 天内，四个或更多节段、后路手术和较长的住院时间是再次手术的危险因素。90 天内，男性、冠心病、四个或更多节段和住院时间较长是再次手术的危险因素。非白人人口统计学和独立的术前门诊状态与再手术率降低有关。