Prevalence and risk factors for unplanned return to oroom for complex adult spinal deformity patients: scoli-risk 1 prospective multicenter international study

Abstract

SUMMARY: This is a prospective, multicentre international study of 272 subjects undergoing complex adult spine deformity (ASD) surgery with 2 year follow-up. The prevalence of unplanned return to operating room (OR) was 22% overall, with 4% within 30 days of index surgery. Risk factors included a more severe neurological deficit, older age, smokers, diabetes, hypertension, and osteoporosis. HYPOTHESIS: The prevalence of unplanned return to OR after ASD surgery is high. DESIGN: A prospective, multicentre international study. INTRODUCTION: A high-risk of complications had been noted in complex ASD surgery. This study reports the prevalence and risk factors of unplanned return to OR in ASD patients who underwent surgical treatment. METHODS: ASD patients who underwent surgical treatment were enrolled prospectively as part of the Scolirisk 1 study and followed for 2 years. Clinical profiles and complications were recorded preoperatively and throughout the follow-up period. RESULTS: 272 ASD patients were assessed. A total of 86 unplanned additional spine surgeries were performed on 60 subjects(22%). Eleven additional surgeries were performed within 30 days of the indexed surgery, 6 of which were due to wound infections, and one each of dural tear, CSF leak, inadequate correction, implant failure, graft dislodgement. For those returned to the operating room after 30 days from the indexed surgery (75), causes included implant failure(46%), wound infections (22%), loss of correction(16%), pseudarthrosis(15%), proximal junctional kyphosis(7%), adjacent segment problems(8%), screw loosening(5%), screw malposition(5%), prominent implants(3%), and vertebral fracture(3%). Preexisting risk factors that predicted one or more unplanned return to surgery included a more severe neurological deficit (p=0.01), older age (p=0.05), smokers (p=0.03), diabetes (p=0.05), hypertension (p=0.04), and osteoporosis (p=0.02). CONCLUSION: There is a high rate of unplanned return to OR after complex ASD surgery. Risk factors were determined and maybe useful for preoperative counselling of patients undergoing such surgeries, as well as clinical decision making.