Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study

Abstract

Study Design: Multicentric retrospective study, Level of evidence III. Objective: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. Methods: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. Results: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). Conclusion: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

Complications of adult spinal deformity surgery

“…As the fusion techniques are widely used, the number of complications encountered also increases. [ 8 12 13 ] Age, gender, comorbidities, body mass index, smoking, duration of symptoms, number of fused levels, operative time, and blood loss are considered for the risk factors in adult spinal deformity. [ 12 13 14 15 16 ] Montgomery et al .…”

“…[ 8 12 13 ] Age, gender, comorbidities, body mass index, smoking, duration of symptoms, number of fused levels, operative time, and blood loss are considered for the risk factors in adult spinal deformity. [ 12 13 14 15 16 ] Montgomery et al . compared genders regarding complications and outcomes of adult spinal deformity surgery and found no significant difference between the two groups.…”

“…[ 20 ] Low levels of hemoglobin may delay wound healing. [ 13 ] Due to pulmonary disease, steroids could decrease bone mineral density and impairment in the healing of the wound. [ 12 ]…”

“…[ 44 ] Wound infection was one of the main causes of 30-day readmission to hospital. [ 13 ] Uribe et al . revealed the incidence of deep wound infection as 7.6%.…”

“…According to Camino et al ., proximal junctional kyphosis was one of the main reasons for early readmission to hospital. [ 13 ] The common risk factors are poor bone quality, infection, smoking, and hypercorrection of the spine in proximal junctional failure (PJF). [ 13 62 64 65 66 ] Furthermore, it is related to the disruption of posterior soft-tissue and ligamentous structures.…”