Risk Factors for Unplanned Reoperation Within 30 Days Following Elective Posterior Lumbar Spinal Fusion

Retrospective cohort study.

Unplanned reoperation following lumbar spinal fusion is detrimental to patients, providers, and health systems. The aim of this study was to identify risk factors associated with unplanned reoperation following elective posterior lumbar spinal fusion and assess the reasons for reoperation.

A retrospective analysis of 22 151 patients from the American College of Surgeons National Surgical Quality Improvement Program data set between 2012 and 2015 was completed. The primary outcome measure was unplanned reoperation within 30 days. Secondary outcome measures were specific diagnoses and procedures associated with unplanned reoperation, as well as time to reoperation from initial procedure. Multiple stepwise logistic regression was employed to determine preoperative variables predictive of unplanned 30-day reoperation.

Patients with disseminated cancer (OR = 3.44, P = .0049), weight loss >10% in 6 months prior to surgery (OR = 3.26, P = .0276), bleeding disorders (OR = 1.92, P = .0049), American Society of Anesthesiologists score of 3 (OR = 1.46, P < .0001), body mass index of 35.0 to 39.9 (OR = 1.50, P = .0037), body mass index of ≥40 (OR = 1.83, P < .0001), and multilevel fusion (OR = 1.24, P = .0069) exhibited increased odds of 30-day reoperation. The most common diagnosis associated with reoperation was postoperative infection (n = 121, 21.1% of reoperations).

Predictors and causes of unplanned reoperation within 30 days following elective posterior lumbar spinal fusion are identifiable. In this study cohort, obesity, American Society of Anesthesiologists score, disseminated cancer, weight loss, bleeding disorders, and multilevel fusion were identified as significant risk factors for reoperation. Further research investigating risk factor modification on reoperation in elective posterior lumbar spinal fusion is warranted.