Abstract
BackgroundThe need for revision surgery after a spinal surgery can cause a variety of problems, including reduced quality of life for the patient, additional medical expenses, and patient-physician conflicts. The purpose of this study was to evaluate the causes of unplanned revision spinal surgery within a week after the initial surgery in order to identify the surgical issues most commonly associated with unplanned revision surgery.MethodsWe retrospectively reviewed the medical records of all patients at who received a spinal surgery at a regional medical center from July 2004 to April 2011 in order to identify those who required a revision surgery within one week of their initial surgery. Patients were excluded if they received a vertebroplasty, kyphoplasty, or nerve block surgery, because those surgeries are one-day surgeries that do not require hospital admission. In addition, patients with a primary diagnosis of wound infection were also excluded since reoperations for infection control can be expected.ResultsThe overall incidence of unplanned revision spinal surgery during the time period covered by this review was 1.12 % (116/10,350 patients). The most common surgical causes of reoperation were screw malposition (41 patients), symptomatic epidural hematoma (27 patients), and inadequate decompression (37 patients). Screw malposition was the most common complication, with an incidence rate of 0.82 %. Screw instrumentation was significantly associated with revision surgery (p = 0.023), which suggests that this procedure carried a greater risk of requiring revision. The mean time interval to reoperation for epidural hematomas was significantly shorter than the intervals for other causes of revision spinal surgery (p < 0.001), which suggests that epidural hematoma was more emergent than other complications. Also, 25.93 % of patients who underwent hematoma removal experienced residual sequelae; this percentage was significantly higher than for other surgical causes of revision spinal surgery (p = 0.013).ConclusionsThe results suggest that to avoid the need for reoperation, screw malposition, inadequate decompression, and epidural hematoma are the key surgical complications to be guarded against. Accordingly, adequate decompression, epidural hematoma prevention, and proper pedicle screw placement may help reduce the incidence of revision surgery.
Highlights
The need for revision surgery after a spinal surgery can cause a variety of problems, including reduced quality of life for the patient, additional medical expenses, and patient-physician conflicts
The purpose of this study was to evaluate the surgical causes of revision spinal surgery within one week after the initial spinal surgery, as well as the incidence rates of those causes, in order to investigate the association of those procedures with revision surgery and, in turn, to develop potential prevention strategies
We have previously reported that preoperative diastolic blood pressure, intraoperative use of gelfoam for dura coverage, and postoperative drain output are risk factors with statistical significance for symptomatic epidural hematoma [22]
Summary
The need for revision surgery after a spinal surgery can cause a variety of problems, including reduced quality of life for the patient, additional medical expenses, and patient-physician conflicts. The purpose of this study was to evaluate the causes of unplanned revision spinal surgery within a week after the initial surgery in order to identify the surgical issues most commonly associated with unplanned revision surgery. No prior studies have analyzed the short-term results of an initial operation in order to ascertain the potential surgical causes of revision surgeries. The purpose of this study was to evaluate the surgical causes of revision spinal surgery within one week after the initial spinal surgery, as well as the incidence rates of those causes, in order to investigate the association of those procedures with revision surgery and, in turn, to develop potential prevention strategies
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