Returning to the Operating Room After Spinal Surgery

It’s an unfortunate fact that patients can end up back in the hospital after spinal surgery. Sometimes there’s an infection that must be taken care of. In other cases, implants used to hold the spine together during the healing/fusion phase have to be revised. Medical complications such as blood clots, heart problems, breathing difficulties, or gastrointestinal problems can also bring patients back for early readmission after surgery.

In this study, surgeons from New York University Hospital for Joint Diseases went back through their patient records for a two year period of time to see how often these unplanned readmissions occurred and why. Patients included in the study had one of 12 common spine procedures (e.g., spinal fusion, kyphoplasty, laminectomy). There were a total of 3673 people operated on with 156 of these patients requiring return to the hospital. That works out to be a 3.8 per cent overall readmission rate.

Most of the readmissions (90 per cent) were unplanned. In the remaining 10 per cent, the patient was scheduled for a two-part (staged) procedure and came back for the second surgery. Lumbar stenosis (narrowing of the spinal canal) and disc herniation were the two most common problems patients were being treated surgically.

Taking a closer look at the data collected, the authors divided the readmissions into two groups: those who had surgical complications and those who had nonsurgical complications. Infection was definitely the biggest problem for both groups.

Surgical complications occurred most often in patients who had more spinal levels fused (average of six spinal segments). There were difficulties with implants (plates, screws) caused by infection or wound drainage in a smaller number of patients. Nonsurgical complications were most often related to GI problems and systemic illness with a few cases caused by heart, lung, or neurologic conditions.

The next step is to find ways to reduce early readmissions following spinal surgery. A closer analysis of all the factors present in patients who do go back to the hospital might reveal some helpful clues. For example, there may be certain aspects of the surgical procedure that is contributing to the high rate of infection. Or patient factors such as general health, pre-existing conditions (heart disease, cancer) and obesity may make a difference.

In addition to screening patients more carefully before surgery, closer postoperative monitoring may be a useful way to reduce readmissions. The data from this study do support the idea that medical complications after surgery are a big factor. And this may be one cause hospital staff can change with coordinated efforts and planning.