Dott. Luca Antonelli

Specialista in Chirurgia Ortopedica e Vertebrale
Clinical Fellow Università di Toronto-Canada
Responsabile Unità Operativa                                                         
Ospedale Privato Accreditato San Camillo Forte dei Marmi (LU)
Ravenna
Dott. Luca Antonelli

Complicanze e risultati

COMPLICANZE E RISULTATI DELLA CHIRURGIA VERTEBRALE

La chirurgia vertebrale, come tutte le chirurgie più complesse e ad alto tasso di difficoltà, non è scevra da complicanze. Bisogna però premettere che se l’intervento è condotto secondo criteri e modalità rispondenti alle regole ed ai protocolli indicati dalle principali Società Scientifiche del campo, la percentuale di tali complicanze diminuisce significativamente.

The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. 
Ashton CM1, Del Junco DJ, Souchek J, Wray NP, Mansyur CL. 
Med Care. 1997 Oct;35(10):1044-59.
Conclusion: Early readmission is significantly associated with the process of inpatient care. The risk of early readmission is increased by 55% when care is of relatively low quality, that is, substandard or normative instead of normative or exceptional.


Dall’esame di alcune principali pubblicazioni sull’argomento si desume che in definitiva la percentuale globale di tali complicazioni, su casistiche di migliaia di casi operati, è abbastanza bassa; difatti nel recentissimo lavoro pubblicato sulla rivista americana Spine (la più importante rivista scientifica al mondo) il tasso complessivo di complicazioni dopo chirurgie vertebrali di vario tipo è risultato essere del 2.08%.

Unplanned Reoperation of Lumbar Spinal Surgery During the Primary Admission. 
Jia-Ming Liu, MD et al.
SPINE Volume 41, Number 16, pp 1279–1283.
A total of 3936 patients who underwent lumbar spinal surgery from three institutions were reviewed, and 82 (2.08%) required unplanned reoperation during the primary admission because of wound infection (0.94%), screw misplacement (0.53%), cerebrospinal fluid leakage (0.27%), wound hematoma (0.18%) and neurologic deficit (0.15%). For the diagnosis, patients with lumbar spinal spondylolisthesis had a much higher rate of reoperation (4.3%) than those of lumbar stenosis (2.3%), vertebral tumor (2.2%), vertebral fracture (1.2%) and disc herniation (1.1%) with a significant difference (P<0.001). The revision rate was significantly higher in patients underwent posterior lumbar interbody fusion (PLIF) than those received transforaminal lumbar interbody fusion (TLIF) (P = 0.007).

In un'altra importante ricerca effettuata presso l’Università di New York e pubblicato su Spine si è potuto evidenziare che le cause più comuni di reinterventi erano state l’infezione post operatoria, patologie di carattere medico internistico e complicazioni chirurgiche nell'ordine del 3.8% di tutti i casi trattati.

An Analysis of Causes of Readmission After Spine Surgery. 
Richard A. McCormack, MD et al. 
Spine 2012;37:1260–1266
Results. A total of 156 early readmissions were identified, of which 141 were unplanned. Of the unplanned readmissions, the most common causes were infection or a concern for an infection (45 patients, 32% of unplanned readmissions), nonsurgical complications (31 patients, 22% of readmissions), complications requiring surgical revision (21 patients, 15% of readmissions), and wound drainage (12 patients, 9% of readmissions). Fifty-seven percent of unplanned readmissions required a return to the operating room (76% of infections or concern for infection).
length of stay for the unplanned readmissions was 6.5 days. When using the 12 most common procedures based on the International Classification of Diseases, Ninth Revision, Clinical Modification, the early readmission rate was 3.8% (141 early readmissions in 3673 procedures). 
Conclusion. Infection, medical complications after surgery, and surgical complications requiring revision of implants are the primary causes of unplanned early readmissions and spine surgery. Further studies are necessary to identify patients and procedures most associated with readmission. 

Infine vorrei segnalare quest’ultimo lavoro pubblicato su Spine ed effettuato presso l’Hospital for Special Surgery di New York dove si ribadisce che la percentuale di complicazioni dopo chirurgia lombare è relativamente bassa (3.3% di tutti i casi trattati) e che fra tutte le complicazioni quelle relative all’infezione e alla ferita chirurgica sono le più frequenti.

Unplanned Hospital Readmission After Surgical Treatment of Common Lumbar Pathologies.Rates and Causes 
Chibuikem Akamnonu, MD et al
Spine 2015;40:423–428
Results. A total of 1306 patients were identified who underwent surgery for various lumbar pathologies during a 2-year time period. There were a total of 70 readmissions captured in the database that included 14 planned, 43 unplanned readmissions, and 13 coding errors. The unplanned readmission rate varied between 2.1% and 7.1% depending on pathology, with an overall rate of 3.3% within 90 days of discharge. Index length of stay, discharge disposition, severity of illness scores, and surgical approach were associated with readmission. The addition of fusion to decompression procedures did not seem to increase readmission rates. Surgical site infections and wound complications were the 2 most common reasons for readmissions accounting for 72% of all readmissions during the 90- day postdischarge period. 
Conclusion. The rate of readmission after surgery for common lumbar degenerative pathologies is relatively low. Surgical site infections and wound complications were the most common cause of readmission in this patient cohort. 
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