30-Day unplanned surgery in cervical spondylotic myelopathy surgically treated: a single-center experience

• Published in: European spine journal Vol. 28; no. 5; pp. 1209 - 1216
• Main Authors: Plano, Xavier, Ramírez, Manuel, Matamalas, Antonia, Haddad, Sleiman, García de Frutos, Ana, Casamitjana, J. M., Pellisé, Ferran
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2019; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Central nervous system diseases; Cervical Vertebrae - surgery; Diabetes mellitus; Diabetes Mellitus - epidemiology; Female; Hematoma; Hematoma - surgery; Humans; Intraoperative Complications - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Postoperative Complications; Postoperative infection; Regression analysis; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Smoking; Spinal cord; Spinal Cord Diseases - surgery; Spondylosis - surgery; Surgery; Surgical Orthopedics; Surgical Wound Infection - surgery; United States > US; Surgical treatment; Cervical spondylotic myelopathy; Unplanned surgery
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-019-05892-8

Study design
Retrospective cohort study.
Objective
Analyze the rate and risk factors associated with Unplanned Surgeries (US) during the first 30 days in patients treated for cervical spondylotic myelopathy.
Background
US are often regarded as a potentially useful quality of care indicator.
Methods
We defined US as any, non-planned, surgical procedure as a complication after “index” surgery. Demographic data, comorbidities, ASA, smoking status, surgical details and postoperative complications were collected. We conducted a subjective outcome test using the Global Outcome Score (GOS). To assess risk factors, a bivariate analysis was performed using T Student or Chi-square. Risk is shown as odds ratio (OR) with 95% confidence interval (CI). Multivariable logistic regression models with bootstrap resampling procedure were performed.

Results
The study included 303 patients (200 men) with mean age of 57.7 years (27–86) and mean follow-up of 75.35 months (16–126 m). 63.3% patients were ASA 1 or 2 and 41.9% were smokers. 77.9% of patients had some comorbidity. Anterior approach surgeries were 65.7%. Perioperative complications: 29% medical, 8.9% intraoperative and 3% implant related. US rate was 2.6%. Causes for revision were postoperative infection or deep hematomas. After bivariate analysis, the risk factors associated were diabetes mellitus (OR 2.6; 95% CI 1–5.5) and intraoperative complications (OR 6.5, 95% CI 1–40). The presence of US does not have influence in satisfaction using GOS score.
Conclusions
Our US rate was 2.6%, similar to the literature. Diabetics and patients suffering an intraoperative complication are more likely to need an early reinterventions (OR 2.2 and 6.5, respectively). US did not alter the patient’s outcomes.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.