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Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes
BACKGROUND: 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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714439/ https://www.ncbi.nlm.nih.gov/pubmed/26772974 http://dx.doi.org/10.1186/s12891-016-0891-4 |
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author | Tsai, Tsung-Ting Lee, Sheng-Hsun Niu, Chi-Chien Lai, Po-Liang Chen, Lih-Huei Chen, Wen-Jer |
author_facet | Tsai, Tsung-Ting Lee, Sheng-Hsun Niu, Chi-Chien Lai, Po-Liang Chen, Lih-Huei Chen, Wen-Jer |
author_sort | Tsai, Tsung-Ting |
collection | PubMed |
description | BACKGROUND: 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. METHODS: We 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. RESULTS: The 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). CONCLUSIONS: The 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. |
format | Online Article Text |
id | pubmed-4714439 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47144392016-01-16 Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes Tsai, Tsung-Ting Lee, Sheng-Hsun Niu, Chi-Chien Lai, Po-Liang Chen, Lih-Huei Chen, Wen-Jer BMC Musculoskelet Disord Research Article BACKGROUND: 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. METHODS: We 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. RESULTS: The 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). CONCLUSIONS: The 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. BioMed Central 2016-01-15 /pmc/articles/PMC4714439/ /pubmed/26772974 http://dx.doi.org/10.1186/s12891-016-0891-4 Text en © Tsai et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Tsai, Tsung-Ting Lee, Sheng-Hsun Niu, Chi-Chien Lai, Po-Liang Chen, Lih-Huei Chen, Wen-Jer Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes |
title | Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes |
title_full | Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes |
title_fullStr | Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes |
title_full_unstemmed | Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes |
title_short | Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes |
title_sort | unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714439/ https://www.ncbi.nlm.nih.gov/pubmed/26772974 http://dx.doi.org/10.1186/s12891-016-0891-4 |
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