title: Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes.
abstract: BACKGROUND
  The need for revision surgery after a spinal surgery can cause a variety of problems, including reduced quality of life for the patient, additional medical expenses, and patient-physician conflicts. The purpose of this study was to evaluate the causes of unplanned revision spinal surgery within a week after the initial surgery in order to identify the surgical issues most commonly associated with unplanned revision surgery.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients at who received a spinal surgery at a regional medical center from July 2004 to April 2011 in order to identify those who required a revision surgery within one week of their initial surgery. Patients were excluded if they received a vertebroplasty, kyphoplasty, or nerve block surgery, because those surgeries are one-day surgeries that do not require hospital admission. In addition, patients with a primary diagnosis of wound infection were also excluded since reoperations for infection control can be expected.
  
  
  RESULTS
  The overall incidence of unplanned revision spinal surgery during the time period covered by this review was 1.12% (116/10,350 patients). The most common surgical causes of reoperation were screw malposition (41 patients), symptomatic epidural hematoma (27 patients), and inadequate decompression (37 patients). Screw malposition was the most common complication, with an incidence rate of 0.82%. Screw instrumentation was significantly associated with revision surgery (p = 0.023), which suggests that this procedure carried a greater risk of requiring revision. The mean time interval to reoperation for epidural hematomas was significantly shorter than the intervals for other causes of revision spinal surgery (p < 0.001), which suggests that epidural hematoma was more emergent than other complications. Also, 25.93% of patients who underwent hematoma removal experienced residual sequelae; this percentage was significantly higher than for other surgical causes of revision spinal surgery (p = 0.013).
  
  
  CONCLUSIONS
  The results suggest that to avoid the need for reoperation, screw malposition, inadequate decompression, and epidural hematoma are the key surgical complications to be guarded against. Accordingly, adequate decompression, epidural hematoma prevention, and proper pedicle screw placement may help reduce the incidence of revision surgery.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan 333, Linkou, Taiwan. tsai1129@gmail.com.|Chang Gung University, College of Medicine, Taoyuan, Taiwan. tsai1129@gmail.com.|Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. tsai1129@gmail.com.
authors.forename: Tsung-Ting
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan 333, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Sheng-Hsun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan 333, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan 333, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan 333, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan 333, Linkou, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation / Q000639:trends; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors