title: A multi-center study of reoperations within 30 days of spine surgery.
abstract: OBJECTIVE
  To investigate the incidence and causes of reoperations within 30 days of spine surgery.
  
  
  METHODS
  Patients who underwent spine surgery between 2002 and 2012, at one of 9 institutions, were enrolled. The causes of all reoperations, within 30 days of the index surgery, were reviewed. The incidence of reoperations within 30 days were calculated and compared according to the preoperative diagnosis, use of instrumentation, surgical level, and approach. Moreover, the distribution of the causes for reoperations within the 30-day period was also assessed.
  
  
  RESULTS
  The overall incidence of reoperations, within 30 days of spine surgery, was 1.6% (175/10,680). Patients who underwent instrumentation procedures demonstrated a higher incidence of reoperations than patients who underwent procedures without instrumentation (P < 0.001). Moreover, patients diagnosed with preoperative trauma had a higher incidence of reoperation than those with other diagnoses (P < 0.001). Surgical site infection (SSI), postoperative epidural hematoma, pedicle screw malposition, and inadequate decompression were the four main causes of reoperation. Motor paralysis, due to epidural hematoma, was the predominant cause of reoperations during the hyper-acute phase (0-1 days, postoperatively), whereas SSI was the dominant cause during the sub-acute phase (11-30 days, postoperatively).
  
  
  CONCLUSIONS
  This large, multi-center study indicated the causes and incidence of reoperations, within 30 days of the initial spinal surgery. Based on these data, spinal surgeons can provide patients with information that allows them to better understand the surgical risk and expected post-surgical management.
authors.affiliation: Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan. takayosh@kuhp.kyoto-u.ac.jp.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Fujibayashi
authors.affiliation: Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takemoto
authors.affiliation: Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.|Department of Orthopaedic Surgery, Kobe Central General Hospital, Kobe, Japan.
authors.forename: Bungo
authors.initials: B
authors.lastname: Otsuki
authors.affiliation: Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Orthopaedic Surgery, Kitano Hospital, Osaka, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Orthopaedic Surgery, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kusuba
authors.affiliation: Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Youngwoo
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Gakkentoshi Hospital, Kyoto, Japan.
authors.forename: Tsunemitsu
authors.initials: T
authors.lastname: Soeda
authors.affiliation: Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Uchikoshi
authors.affiliation: Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Tsubouchi
authors.affiliation: Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology; D010243:Paralysis / Q000453:epidemiology / Q000601:surgery; D065289:Pedicle Screws / Q000009:adverse effects; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery; D013997:Time Factors; D055815:Young Adult
keywords: 30 days; Incidence; Reoperation; Spine surgery