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Early reintervention after anterior cervical spine surgery: Epidemiology and risk factors: A case-control study
M Boudissa1, J Lebecque2, L Boissière2
1Service de Chirurgie Orthopédique et Traumatologique, CHU Grenoble, 38700 La Tronche, France; Université Joseph-Fourier, Grenoble, France; Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France.
Introduction:
Anterior cervical spine surgery is a frequent and effective procedure; complications are rare, but potentially fatal. The objective of the present study was to assess epidemiology and risk factors for early reintervention in anterior cervical spine surgery.
Methods:
A retrospective case-control study recruited 2319 patients operated on in our department, with 7 years' follow-up. Incidence and prevalence of causes of early reintervention were analyzed. Each case was matched to 2 controls from the same source population. Risk factors were identified and odds ratios (OR) were calculated.
Results:
Thirteen patients (0.6%: 3 female, 10 male; mean age, 59±12 years) underwent surgical reintervention within 72hours. Causes comprised: retropharyngeal hematoma (0.2%), epidural hematoma (0.3%) and dural breach (0.04%). As risk factor for early reintervention, only ASA score≥3 proved significant (OR: 5.5; 95% confidence interval: 1.1-29.85). As risk factor for epidural hematoma, only smoking proved significant (OR: 14.67; 95% confidence interval: 1.16-185.29). No risk factors emerged for onset of retropharyngeal hematoma.
Conclusion:
ASA score≥3 and smoking entail risk of epidural hematoma and early reintervention. Postoperative pain, neurologic deficit, dysphagia, dysphonia, dyspnea and agitation suggest onset of complications, requiring necessary measures to be taken. Implementation of drainage fails to prevent such complications.
