Analysis Of Risk Factors Of Unplanned Reoperation In Spinal Surgery

Objective:By collecting and studying the clinical data of patients undergoing spinal surgery in our hospital,and reading a large number of domestic and foreign literature,to identify high risk factors for unplanned reoperation through statistical methods,give suggestion to clinical doctors on key points for treatment.Then,summarize the experience and improve the methods,and provide the corresponding countermeasures to reduce the occurrence of unplanned reoperation.Methods:A retrospective survey was conducted on 103 unplanned reoperation cases of spinal surgery form January 2013 to April 2017.The basic conditions of the patients were found in the operation records and the hospital medical record information system.The data were analyzed to find out the related factors of unplanned reoperation and put forward the corresponding countermeasures.The basic situation and information of surgical patients were found through surgical records and hospital records information system,including sex,age,past history(hypertension,diabetes),smoking history,drinking history,complication(anemia,hypoproteinemia),emergency operation,the cause of first operation,the time of first operation,the grade of first operation,the time of reoperation,the causes of reoperation and patient recovery.Then establish the database,the SPSS 22.0software is used for statistical processing to find out the related risk factors which can easily lead to the recurrence of unplanned operation,and put forward the corresponding countermeasures for the reasons.Results:1.there were 103 cases of unplanned reoperation in spinal surgery in our hospital,the incidence rate was 1.11%(103/9279).2.The minimum age was 3 years old,the maximum age was 73 years old and the average age was(53.66+11.42)years old in the reoperation group.The minimum age was 3 years old,the maximum age was 76 years old,the average age was(45.18+14.17)years old in the control group,the difference was statistically significant(t=4.384,P=0.013).3.There were 74 males and 29 females in the reoperation group.There were192 male patients and 108 female patients in the control group,and the difference was not statistically significant(X~2=2.103,P=0.147).4.The unplanned reoperation was performed at 6h-79d after the initial operation and average interval from the reoperation to the primary operation was12.56±21.09 days.5.In 103 cases of unplanned reoperation,there were 18 cases of cervical vertebra related diseases(8 cases of cervical fracture,7 cases of cervical disc herniation,3 cases of cervical spinal cord injury),8 cases of thoracic vertebra related diseases(6 cases of thoracic vertebra fracture,2 cases of ligamentum flavum calcification in thoracic vertebra),62 cases of lumbarl vertebra related diseases(12cases of lumbar vertebra fracture,44 lumbar intervertebral disc herniation,6 cases of lumbar spondylolisthesis),4 cases of spinal deformity,3 cases of spinal tumors and 8 cases of spinal tuberculosis.6.There were 83 cases in grade four and 20 cases in grade three in the reoperation group.There were 246 cases in grade four and 54 cases in grade three in the control group.There was no grade I or grade two operation in the two groups,and the difference was statistically significant(X~2=4.835,P=0.028).7.The reoperation group of 28 patients with hypertension;the control group of62 patients with hypertension,the difference was not statistically significant(X~2=1.878,P=0.171).8.The reoperation group of 15 patients with diabetes mellitus;the control group of 21 patients with diabetes mellitus,the difference was statistically significant(X~2=5.391,P=0.020).9.The reoperation group of 12 patients with anemia(men's hemoglobin value less than 120g/L,women's hemoglobin value less than 110g/L);the control group of17 patients with anemia,the difference was statistically significant(X~2=4.111,P=0.043).10.The reoperation group of 21 patients with hypoalbuminemia(albumin less than 35g/L);the control group of 32 patients with hypoalbuminemia,the difference was statistically significant(X~2=6.345,P=0.012).11.The reoperation group of 26 patients with smoking history;the control group of 84 patients with smoking history,the difference was not statistically significant(X~2=0.294,P=0.588).12.The reoperation group of 31 patients with drinking history;the control group of 72 patients with drinking history,the difference was not statistically significant(X~2=1.498,P=0.221).13.In the cause of unplanned reoperation,postoperative hematoma formed compression nerve,incision infection and poor healing were the main factors,which accounted for 38 cases(36.89%)and 36 cases(34.95%).Other reasons included 10cases of unsuccessful results,7 cases of intraoperative misoperation,6 cases of postoperative loosening and internal fixation,and 6 cases of cerebrospinal fluid leakage.14.The reoperation group of 6 patients with emergency operation,the control group of 34 patients with emergency operation,the difference was not statistically significant(X~2=2.602,P=0.107).15.In 103 cases of unplanned reoperation,79 cases(76.70%)were cured,21cases(20.39%)were improved,3 cases(2.91%)were unhealed,and 0 cases died.The cure rate of unplanned reoperation was 97.09%.Conclusion:The causes of unplanned reoperation were postoperative hematoma compression of nerve,incision infection and poor healing,failure,improper operation,internal fixation loosening and cerebrospinal fluid leakage.Patients'age,diabetes,anemia,hypoproteinemia,and surgical difficulty are non-iatrogenic risk factors that lead to unplanned reoperations.Lack of hospital management and negligence of doctors are the iatrogenic factors that lead to unplanned reoperations.