423 - Risk Factors for Reoperation Following Elective Cervical Spine Surgery...

#423 Risk Factors for Reoperation Following Elective Cervical Spine Surgery: An Analysis of 3,922 Patients from the ACS NSQIP Database

Cervical Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

S.V. Nandyala (1)
A.J. Marquez-Lara (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), or posterior cervical decompression (PCD) without fusion are procedures indicated for the surgical treatment of cervical spinal disease. The purpose of this study was to examine the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify risk factors for reoperations following cervical spine surgery.

Methods: The ACS NSQIP database collects data on 30-day peri-operative outcomes of surgical procedures. We analyzed the NSQIP database in 2011 to identify patients undergoing elective ACDF, PCF, or PCD for degenerative diagnoses. Patients with a diagnosis of trauma, infection, tumor, and deformity were excluded. We compared patients requiring a reoperation within 30 days for any cause to those patients who did not require early reoperation. Preoperative patient health characteristics, preoperative laboratory values, surgery and hospital outcomes (operative time, length of stay (LOS), readmission and reoperation rates, and mortality) were compared between groups. Statistical analysis was performed with SPSS v.20 using independent t-tests and χ2-tests for continuous and categorical variables, respectively. Multivariate logistic regression was performed to identify independent predictors for reoperations. The regression model included only preoperative and intraoperative variables that approached statistical significance (p< 0.1) on univariate analysis. P-values ≤ 0.05 were considered statistically significant.

Results: A total of 3,922 patients that underwent elective cervical spine surgery were identified (ACDF %, PCF %, PCD %). 53.4% of patients requiring a reoperation underwent an ACDF (p< 0.0001). PCD procedures were more likely to require reoperation (OR=4.38) compared to ACDFs. There were no significant differences in age, gender, or race between groups. Co-morbidities that were more prevalent among patients requiring reoperations included diabetes mellitus, hypertension, vascular disease, and paralysis (p< 0.05). Patients that had a prior operation within 30 days before the elective procedure were statistically more likely to require a reoperation within 30 days following (4.4% vs. 0.5%, p=0.016). Preoperative creatinine was also statistically greater among patients requiring a reoperation (1.167 vs. 0.913 mg/dL, p=0.001). The length of the initial hospitalization was significantly increased for patients with a reoperation (6.95 vs. 2.01 days, p< 0.0001). The most common complications associated with reoperation were wound infections and dehiscence (29.3% vs. 0.5%, p< 0.0001). Other medical complications more frequently associated with reoperations (p< 0.0001) included sepsis (6.9% vs. 0.3%), urinary tract infections (5.2% vs. 0.8%), cardiac events (5.2% vs. 0.3%), and DVTs (5.2% vs. 0.2%). Despite increased morbidity, there was no significant difference in mortality (0.00% with a reoperation vs. 0.18%, p=0.746). Multivariate regression demonstrated risk factors for early reoperation to include peripheral vascular disease (OR=13.9), a recent operation (OR=11.9), diabetes (OR=4.01), and increased operative times (OR=1.005 per minute).

Conclusions: Early reoperations following cervical spine surgery are associated with increased hospitalizations and adverse outcomes for the patient. Wound complications are the most common reason for reoperation in the early post-operative period. In this study we identified independent predictors for reoperation to include peripheral vascular disease, a recent operation within 30 days, diabetes, increased operative time, and PCD procedures. The risk factors identified should be considered when counseling patients regarding the risks of surgery.