Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2022; 89(4):243-251 | DOI: 10.55095/achot2022/040

Komplikace ve spondylochirurgii: prospektivní 13leté sledování neplánovaných revizních operací páteřePůvodní práce

P. NESNÍDAL^1,3,*, J. ŠTULÍK¹, J. ŠTULÍK ML.², J. KRYL¹, T. VYSKOČIL¹, M. BARNA¹

¹ Klinika spondylochirurgie 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha

² Oddělení klinické mikrobiologie, Nemocnice Rudolfa a Stefanie Benešov, a.s.

³ Ústav hygieny a epidemiologie 1. lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice v Praze, Praha

PURPOSE OF THE STUDY:
Unplanned revision spinal surgeries constitute a complication in the treatment algorithm for the patient, surgeon and the entire treatment team. Any complication leading to an unplanned revision surgery is therefore undesirable. The percentage of complications referred to in publications on this topic focusing on unplanned revision surgeries only varies from 0.7% to 29.8%, with obvious diversity of causes and significant risk factors. The purpose of the submitted paper is to carry out a prospective evaluation of the most serious complications requiring unplanned revision spinal surgeries in the course of 13 years at a single department performing a broad range of spinal surgeries, namely 1300 procedures annually on average.

MATERIAL AND METHODS:
In the period 2006 - 2018, a total of 16872 patients underwent a surgery at our department. During this period, in 556 patients an unplanned revision spinal surgery was performed. In agreement with literature, the patients were categorised by cause for revision: 1/ impaired wound suprafascial (superficial) healing - superficial infection, 2/ impaired wound subfascial (deep) healing - deep infection, 3/ surgical wound hematoma, 4/ deterioration or occurrence of new neurological symptoms, 5/cerebrospinal fluid leak (liquorrhoea) and 6/ others. The patients operated on for inflammatory diseases of the spine with subsequent infectious complications, primarily treated at another department, and the patients with open spinal injury were excluded from the study. According to these criteria, a cohort of 521 patients was followed up, namely 236 (45.3%) women and 285 (54.7%) men, aged 1 year to 86 years, with the mean age of 55.0 years (median 60 years). Demographic effects, tobacco smoking and comorbidities were followed up in the cohort, together with the effects of surgery, diagnosis, surgical approach and physician. All parameters were statistically evaluated at a p-value below 0.05, including comparison with the control group.

RESULTS:
Of the total number of 16872 operated patients, a group of 521 (3.09%) patients undergoing a revision surgery for complications was analysed in detail. Impaired wound healing - infection (SSI) was found in 199 (1.18%) patients, of whom superficial infection in 124 cases (0.73%) and deep infection in 75 cases (0.44%). Hematoma in a surgical site was detected in 149 (0.88%) patients. In 63 (0.37%) cases, deterioration of the existing neurological finding or occurrence of a new neurological finding were observed, in 68 (0.40%) cases cerebrospinal fluid leak was reported and in 40 (0.24%) cases other complications were identified. As concerns the surgical assistant, the percentage of complications in a board-certified physician is 2.77 (1.14 - 3.29%), in a medical resident it increases to 3.60 (0.00 - 9.38%) (p

Klíčová slova: spinal surgery, complications, infection, reoperation, risk factor, hematoma, cerebrospinal fluid leak, screw malposition, smoking, obesity

Zveřejněno: 15. srpen 2022  Zobrazit citaci