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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

  • Author Footnotes
    # Hanqiang Ouyang and Yuanyu Hu contributed equally to this work and share the first authorship.
    Hanqiang Ouyang
    Footnotes
    # Hanqiang Ouyang and Yuanyu Hu contributed equally to this work and share the first authorship.
    Affiliations
    Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
    Search for articles by this author
  • Author Footnotes
    # Hanqiang Ouyang and Yuanyu Hu contributed equally to this work and share the first authorship.
    Yuanyu Hu
    Footnotes
    # Hanqiang Ouyang and Yuanyu Hu contributed equally to this work and share the first authorship.
    Affiliations
    Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
    Search for articles by this author
  • Wenshuang Hu
    Affiliations
    Department of Medical Affairs, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
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  • Hua Zhang
    Affiliations
    Research Center of Clinical Epidemiology, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
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  • Zhuoran Sun
    Affiliations
    Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
    Search for articles by this author
  • Yanchao Tang
    Affiliations
    Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
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  • Yu Jiang
    Affiliations
    Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
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  • Jianming Chen
    Affiliations
    Department of Medical Record, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
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  • Shu Dong
    Affiliations
    Department of Medical Affairs, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
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  • Weishi Li
    Correspondence
    Corresponding author. Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China. Tel.: (86) 10-82267362; fax: (86) 010-82267368.
    Affiliations
    Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
    Search for articles by this author
  • Yun Tian
    Correspondence
    Corresponding author. Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China. Tel.: (86) 10-82267362; fax: (86) 010-82267368.
    Affiliations
    Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China

    Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
    Search for articles by this author
  • Author Footnotes
    # Hanqiang Ouyang and Yuanyu Hu contributed equally to this work and share the first authorship.

      Highlights

      • The rate of unplanned reoperation in 35,246 spinal patients was 0.84% based on a single center from 2016 to 2021.
      • The chief reasons for reoperation in 30 days after spine surgery included hematoma, wound infections, neurologic deficit, and pedicle screw malposition.
      • Patients with a diagnosis of anemia, osteoporosis, ankylosing spondylitis, foot drop, deep venous thrombosis, and previous surgical history were significantly associated with a higher incidence of unplanned reoperation.

      Abstract

      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.

      Keywords

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