Surgical site infection most common reason for early reoperation following lumbar fusion surgery

Shuai Kang Wang et al conducted a retrospective cohort study to determine the rates and indications of reoperations following primary lumbar fusion, as well as the independent risk factors for early and late reoperation. The study was conducted at Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing , China.

The authors found that - the most common reasons for early reoperation and late operation were surgical site infection and adjacent segment diseases, respectively. Osteoporosis and diabetes were independent risk factors for early reoperation, and multilevel fusion was independent risk factor for late reoperation.

The researchers retrospectively reviewed patients who underwent lumbar fusion surgery. All patients were followed up for more than 2 years. Characteristics, laboratory tests, primary diagnosis and surgery related variables were compared among the early reoperation (3 months) and the non-reoperation groups. Multivariable logistic regression analysis was used to identify independent risk factors for early and late reoperations.

Inclusion criteria for this study were: (1) age older than 18 years, (2) patients underwent elective primary TLIF surgery due to the failure of conservative treatment and (3) surgical segments less than six. Then, patients diagnosed with spinal fracture, any spinal infection or any malignancy was excluded; patients with follow-up times less than 2 years were also excluded.

The observations of the study were:

• Of 821 patients included in study, 34 patients underwent early reoperation, and 36 patients underwent late reoperation.

• The cumulative reoperation rate was about

4.1% (95% CI 3.8–4.5%) at 3 months,

6.2% (95% CI 5.9–6.5%) at 1 year and

8.2% (95% CI 8.0–8.5%) at 3 years.

• Multivariable analysis indicated that osteoporosis (odds ratio [OR] 3.6, 95% CI 1.2–10.5, p=0.02) and diabetes (OR 2.1, 95% CI 1.1–4.5, p=0.04) were independently associated with early reoperation and multilevel fusion (OR 2.4, 95% CI 1.1–5.4, p=0.03) was independently associated with late reoperation.

• Age, weight, BMI, operative time and estimated blood loss (EBL) were not significantly associated with reoperation.

The authors commented "Although the patient's lower back pain was significantly improved after the reoperation, the VAS score was lower in the non-reoperation group than in the reoperation group at the final follow up point. The future studies should consider the effects of follow up periods on results."

Further reading:

Incidence and risk factors for early and late reoperation following lumbar fusion surgery

Shuai Kang Wang, Peng Wang et al.

Journal of Orthopaedic Surgery and Research (2022) 17:385

https://doi.org/10.1186/s13018-022-03273-4