Tag: Revision rate

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Reoperation, Readmission, and Discharge Disposition for PatientsWith Degenerative Lumbar Pathology Treated With Either Open or Minimally Invasive Techniques

Neurosurgery 2020 DOI:10.1093/neuros/nyaa246

Spine surgery has been transformed by the growth of minimally invasive surgery (MIS) procedures. Previous studies agree that MIS has shorter hospitalization and faster recovery time when compared to conventional open surgery. However, the reoperation and readmission rates between the 2 techniques have yet to be well characterized.

OBJECTIVE: To evaluate the rate of subsequent revision between MIS and open techniques for degenerative lumbar pathology.

METHODS: A total of 1435 adult patients who underwent lumbar spine surgery between 2013 and 2016were included in this retrospective analysis. The rates of need for subsequent reoperation, 30- and 90-d readmission, and discharge to rehabilitation were recorded for both MIS and traditional open techniques. Groups were divided into decompression alone and decompression with fusion.

RESULTS: The rates of subsequent reoperation following MIS and open surgerywere 10.4% and 12.2%, respectively (P = .32), which were maintained when subdivided into decompression and decompression with fusion. MIS and open 30-d readmission rates were 7.9% and 7.2% (P = .67), while 90-d readmission rates were 4.3% and 3.6% (P = .57), respectively. Discharge to rehabilitation was significantly lower for patients under 60 yr of age undergoing MIS (1.64% vs 5.63%, P = .04).

CONCLUSION: The use of minimally invasive techniques for the treatment of lumbar spine pathology does not result in increased reoperation or 30- and 90-d readmission rateswhen compared to open approaches. Patients under the age of 60 yr undergoing MIS procedures were less likely to be discharged to rehab.

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After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries With 2-Year Follow-up

Neurosurgery 83:69–75, 2018

In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies reflects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO.

OBJECTIVE: To investigate if performance of 3CO surgeries improves with years of practice. METHODS:Patientswhounderwent 3COfor spinal deformity with intra/postoperative and revision data collected up to 2 yrwere included. Patientswere chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t-test. Postoperative and revision rates were compared using Chi-square analysis.

RESULTS: Five hundred seventy-three patients were stratified into: G1 (n=143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4=49.2 vs G1=38.3, P=.001), and received a larger osteotomy resection (G4 = 26◦ vs G1 = 20◦, P = .011) than the earliest group. There was a decrease in revision rate (45%, 35%, 33%, 30%, P = .039), notably in revisions for pseudarthrosis (16.7% G1 vs 6.9% G4, P = .007). Major complication rates also decreased (57%, 50%, 46%, 39%, P = .023) as did excessive blood loss (>4 L, 27.2 vs 16.7%, P =.023) and bladder/bowel deficit (4.2% vs 0.7% P=.002). Successful outcomes (no complications or revision) significantly increased (P = .001).

CONCLUSION:Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.

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