Unplanned reoperation within 30 days of fusion surgery for spinal deformity

Abstract

No recent studies have analyzed the rates of or reasons for unanticipated revision surgery within 30 days of primary surgery in spinal deformity patients. Our aim was to examine the incidence, characteristics, reasons, and risk factors for unplanned revision surgery in spinal deformity patients treated at one institution. All patients with a diagnosis of spinal deformity presenting for primary instrumented spinal fusion at a single institution from 1998 to 2012 were reviewed. All unplanned reoperations performed within 30 days after primary surgery were analyzed in terms of demographics, surgical data, and complications. Statistical analyses were performed to obtain correlations and risk factors for anticipated revision. Of 2758 patients [aged 16.07 years (range, 2-71), 69.8% female] who underwent spinal fusion surgery, 59 (2.1%) required reoperation within 30 days after primary surgery. The length of follow up for each patient was more than 30 days. Of those that required reoperation, 87.0% had posterior surgery only, 5.7% had anterior surgery, and 7.3% underwent an anteroposterior approach. The reasons for reoperation included implant failure (n = 20), wound infection (n = 12), neurologic deficit (n = 9), pulmonary complications (n = 17), and coronal plane imbalance (n = 1). The risk factors for reoperation were age, diagnosis, and surgical procedure with osteotomy.

Figure 1. Patient is a 15 year-old female with Marfan syndrome with scoliosis.

A and B, Standing preoperative anteroposterior and lateral radiographs. C and D, Standing anteroposterior and lateral radiographs 4 days after operation. E, Magnetic resonance images, showing improper implant location. F and G, Standing anteroposterior and lateral radiographs 4 days after reoperation.

Figure 2. Patient is a 20 year-old male with congenital scoliosis.

A and B, Standing preoperative anteroposterior and lateral radiographs. C and D, Standing anteroposterior and lateral radiographs 4 days after operation. E, Magnetic resonance images showing improper implant location. F and G, Standing anteroposterior and lateral radiographs 5 days after reoperation.

Figure 3. Patient is a 16 year-old female with neuromuscular scoliosis.

A and B, Standing preoperative anteroposterior and lateral radiographs. C and D, Standing anteroposterior and lateral radiographs 4 days after operation showing pedicle screw loosening. E and F, Standing anteroposterior and lateral radiographs 5 days after reoperation.

Figure 4. Diagnosis and Reoperation Rates.

The statistically significant differences compared with the control are noted as *p<0.05, **p<0.01 and ***p<0.001. Others include syndrome-related scoliosis, ankylosing spondylitis, achondroplasia with scoliosis.