Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity

Taniguchi, Yuki; Ohara, Takahiro; Suzuki, Satoshi; Watanabe, Kota; Suzuki, Teppei; Uno, Koki; Yamaguchi, Toru; Yanagida, Haruhisa; Nakayama, Keiichi I.; Kotani, Toshiaki; Watanabe, Kei; Hirano, Tôru; Yamamoto, Takuya; Kawamura, Ichiro; Sugawara, Ryo; Takeshita, Katsushi; Demura, Satoru; Oku, Norihiro; Sato, Tatsuya; Fujiwara, Keiichi; Akazawa, Tsutomu; Murakami, Hideki; Kakutani, Kenichiro; Matsubayashi, Yoshitaka; Kawakami, Noriaki

doi:10.1097/brs.0000000000003822

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Kim et al 15 summarized 1590 cases of reoperation in 33,840 spine surgeries from 2006 to 2015 and noted that wound complications and infections were the most common reasons. Taniguchi et al 16 analyzed 68 cases of reoperation in 1417 cases of pediatric spinal deformity. However, they concluded that implant failure and infection were the most common causes of reoperation.…”

Section: Discussionmentioning

confidence: 99%

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients

Ouyang

Yang

et al. 2022

Spine

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Study Design. A retrospective study. Objective. The purpose of this study is to identify the incidences, causes, and risk factors of 30-day unplanned reoperation of posterior surgery for thoracic spinal stenosis (TSS) based on 1948 patients in a single center. Summary of Background Data. Unplanned reoperation is suggested to be a useful quality indicator for spine surgery. However, the incidences, causes, and risk factors of 30-day unplanned reoperation in patients who underwent posterior spinal surgery for TSS have not been well-established. Materials and Methods. We retrospectively analyzed the clinical data of patients who underwent posterior spinal surgery for TSS from January 2011 to December 2021. Statistical methods including univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors. Results. A total of 1948 patients who underwent posterior spinal surgery for TSS in our institution were reviewed, and 77 (3.95%) required unplanned reoperations within 30 days because of epidural hematoma (1.64%), wound-related complications (1.02%), inadequate decompression (0.41%), and implant malposition or failure (0.36%), neurological deficit (0.26%), and other causes (0.26%). After univariate analysis, seven clinical factors were associated with unplanned reoperation (P<0.05). Multivariate logistic regression analysis showed that upper thoracic spine surgery (P=0.010), thoracic kyphosis ≥45° (P=0.039), and intraoperative dural injury (P=0.047) were independent risk factors for 30-day unplanned reoperation of posterior surgery for TSS. Conclusions. The incidence of 30-day unplanned reoperations after posterior surgical treatment for TSS was 3.95%. The most common causes were epidural hematoma, wound-related complications, inadequate decompression, and implant malposition or failure. Upper thoracic spine surgery, thoracic kyphosis ≥45°, and intraoperative dural injury led to an increased risk of unplanned reoperation within 30 days after posterior spinal surgery for TSS. Level of Evidence. 4.

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Section: Discussionmentioning

confidence: 99%

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients

Ouyang

Yang

et al. 2022

Spine

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“…For patients undergoing surgery for spinal deformity, we further collected the data of preoperative Cobb angle, the number of fused vertebrae, and the etiology of spinal deformity. Regarding the etiology of spinal deformity other than L5 spondylolisthesis, we classified the etiology into four categories according to the previous work by Taniguchi et al: (a) congenital or structural, (b) neuromuscular, (c) syndromic, and (d) idiopathic curves 19,20) .…”

Section: Collected Baseline Data Of Patientsmentioning

confidence: 99%

Clinical Feasibility of Completely Autologous Fibrin Glue in Spine Surgery

Taniguchi

Matsubayashi

Ikeda

et al. 2022

Spine Surg Relat Res

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Introduction Fibrin glue is widely used in spine surgery. Nevertheless, no report has demonstrated the feasibility of completely autologous fibrin glue (CAFG) in spine surgery. This study aims to investigate the safety, efficacy, and effect of bone fusion of CAFG on spine surgery. Methods We retrospectively extracted data of patients who underwent primary spine surgery with preoperatively prepared CAFG. Primary outcomes were the incidence of wound-related unplanned reoperations within 90 days following primary surgery and the occurrence of reoperation for the management of cerebrospinal fluid (CSF) leakage in patients who had been treated with CAFG used as dural sealants. The effect of CAFG on bone fusion was also assessed by detecting implant failure at one year postoperatively in patients aged 25 years or less undergoing primary fusion for idiopathic scoliosis. Results We identified 131 eligible patients (47 males and 84 females) with a mean age of 32.3 years. CAFG was used most frequently as an adhesive for fixation of graft bone (110 patients), followed by as a dural sealant for CSF leakage in 17 patients, and as a local hemostatic agent in four patients. Wound-related reoperations were identified in four patients (3.1%), which included three for surgical site infection, and one for postoperative epidural hematoma. There was no reoperation required for the management of CSF leakage among 17 patients with dural incision or incidental durotomy. Compared with the control cohort, the use of CAFG was not associated with early wound-related reoperations or implant failure in patients with spinal deformity. Conclusions We demonstrated the clinical feasibility of CAFG in spine surgery. The use of CAFG was not associated with the incidence of reoperations for wound-related complications. CAFG worked effectively as a dural sealant for preventing CSF leakage. CAFG had no beneficial or adverse effect on spinal bone fusion.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Consequently, these children may require increased hospital length of stay (LOS), unplanned readmissions to hospital or Intensive Care Unit, and unplanned return to the operating room. 2,20,21 SSI specifically has been shown to result in poorer outcomes of spinal surgery for children with cerebral Palsy (CP). 22,23 For adults undergoing complex spinal surgery, preoperative evaluation and management by a multidisciplinary team has been effective in reducing the incidence of complications.…”

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confidence: 99%

“…Complications may include surgical site infection (SSI) and pulmonary problems including respiratory failure, gastrointestinal (GI) system disorders, large volume blood loss, implant-related problems, and perioperative mortality 1–19. Consequently, these children may require increased hospital length of stay (LOS), unplanned readmissions to hospital or Intensive Care Unit, and unplanned return to the operating room 2,20,21. SSI specifically has been shown to result in poorer outcomes of spinal surgery for children with cerebral Palsy (CP) 22,23…”

mentioning

confidence: 99%

Does Routine Subspecialty Consultation Before High-Risk Pediatric Spine Surgery Decrease the Incidence of Complications?

Visser

Lehman

Armstrong

2022

Journal of Pediatric Orthopaedics

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Background: Children with neuromuscular disorders and syndromic scoliosis who require operative treatment for scoliosis are at increased risk for postoperative complications. Complications may include surgical site infection and pulmonary system problems including respiratory failure, gastrointestinal system disorders, and others. The purpose of our study was to determine the effect of a standardized perioperative pathway specifically designed for management of high-risk pediatric patients undergoing surgery for scoliosis. Methods: The High-Risk Protocol (HRP) at our institution is a multidisciplinary process with subspecialty consultations before scoliosis surgery. This was a retrospective chart and radiographic review at a single institution. Inclusion criteria were high-risk subjects, age 8 to 18 years old, who underwent surgery between January, 2009 and April, 2009 with a minimum 2-year follow-up. Diagnoses included neuromuscular scoliosis or Syndromic scoliosis.Results: Seventy one subjects were analyzed. The mean age was 13 ( ± 2 SD) years. Follow-up was 63 ( ± 24 SD) months. The study group consisted of 35 subjects who had fully completed the HRP and the control group consisted of 36 subjects who did not. Nine of the 35 (26%) subjects in the HRP had surgery delayed while interventions were performed. Compared with controls, the study group had larger preoperative and postoperative curve magnitudes: 90 versus 73 degrees (P = 0.002) and 35 versus 22 degrees (P = 0.001). Pulmonary disease was more common in the HRP, 60 versus 31% (P = 0.013). The overall incidence of complications in the study group was 29% (10 of 35 subjects) and for controls 28% (10 of 36). There were no differences between groups for types of complications or Clavien-Dindo grades.Three subjects in the study group and 1 in the controls developed surgical site infection. Eleven subjects required unplanned reoperations during the study period. Conclusions: The findings of our study suggest a structured pathway requiring routine evaluations by pediatric subspecialists may not reduce complications for all high-risk pediatric spine patients. Selective use of consultants may be more appropriate.

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Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity

Cited by 6 publications

References 26 publications

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients

Clinical Feasibility of Completely Autologous Fibrin Glue in Spine Surgery

Does Routine Subspecialty Consultation Before High-Risk Pediatric Spine Surgery Decrease the Incidence of Complications?

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