The most common reasons people need spine reoperations—in China—are epidural hematoma, wound infections, neurological deficit, and pedicle screw malposition, a new study shows.
What Causes Most Spine Reoperations—in China?
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Secondary#neurologicdeficit#spinereoperation#woundinfections
The factors that most increased a person’s risk (again, in China) within 30 days post index surgery were anemia, osteoporosis, ankylosing spondylitis, preoperative foot drop, deep venous thrombosis, and previous surgical history.
The study, “Incidences, Causes and Risk Factors of Unplanned Reoperations within 30 Days of Spine Surgery; A Single-Center Study Based on 35,246 Patients,” was published online on July 22, 2022 in The Spinal Journal.
The rate of unplanned reoperations in 35,246 spinal patients was 0.84% based on data from a single center from 2016 to 2021. They found the main reasons for reoperation in the 30 days after spine surgery included hematoma, wound infections, neurologic deficit, and pedicle screw malposition.
The research team also found that patients who have anemia, osteoporosis, ankylosing spondylitis, foot drop, deep venous thrombosis, or previous surgical history had a higher chance of an unplanned reoperation.
Percentages of patients who needed unplanned reoperations included: 3.23% of patients with a thoracic degenerative disease, 1.63% of patients with a spinal tumor, 1.50% of patients with a spinal deformity, 0.61% of patients with atlantoaxial, 0.65% of patients with cervical degenerative disease and 0.82% of patients with lumbar degenerative disease.
The unplanned reoperations were classified as hyperacute (45.45%), acute (30.98%), subacute (15.82%), or chronic (7.74%). The univariate analysis showed that 20 clinical factors were associated with unplanned reoperation (p < 0.05). And the Multivariate Poisson regression analysis indicated that anemia (p < 0.001), osteoporosis (p = 0.048), ankylosing spondylitis (p = 0.08), preoperative foot drop (p = 0.011), deep venous thrombosis (p < 0.001) and previous surgical history (p < 0.001) were independent risk factors for unplanned spinal reoperation.
The study authors included Hangiang Ouyang, M.D., Yuanyu Hu, MM, Wenshuang Hu, MPH, Hua Zhang, M.D., Zhuoran Sun, M.D., Yanchao Tang, M.D., Yu Jiang, M.D., Jianming Chen, BS, Shu Dong, MPH, Weishi Li, M.D. And Yun Tian, M.D., all from Peking University Third Hospital in Beijing, China.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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