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reoperation

Reoperation

Term used by surgeons for the duplication of a surgical procedure. Repeating surgery may involve surgery at the same site, at another site for the same condition, or to repair a feature from a previous surgery.

Although reoperation has been utilized as a metric of quality of care, no national analysis has evaluated the rate of, reasons for, and predictors of unplanned reoperation after craniotomy for tumor.

Unplanned cranial reoperation was primarily associated with operative indices, rather than preoperative characteristics, suggesting that reoperation may have utility as a quality indicator. Hypertension and thrombocytopenia are potentially modifiable predictors of reoperation for hematoma, which were associated greater odds of 30-day death 1).

Postoperative bleeding

The aim of a study was to investigate the incidence of unplanned reoperations from all causes due to bleeding in neurosurgical patients.The medical records of patients who received neurosurgical procedures at the hospital were retrospectively reviewed and data of patients who received reoperations were extracted and summarized. A literature review was conducted of the Medline, Cochrane, EMBASE, and Google Scholar databases up to November 2013. The main outcome measure was the rate of unplanned reoperations due to bleeding.At this hospital, 68 patients with a mean age of 41.5 ± 21.5 years (range, 7 months to 76 years) received an unplanned reoperation. More than 70% of the patients were older than 18 years, 64.7% were males, and 94.1% had cranial surgery. Almost 60% of the patients received >1 blood transfusion (58.8%) after the first surgery. Of the 68 patients, 35 (51.5%) received a second operation due to bleeding. Univariate logistic regression analysis only showed that an increasing time interval between the first and second surgery was associated with a decreased chance of the reoperation being performed due to bleeding (odds ratio [OR] = 0.843, 95% confidence interval [CI]: 0.720-0.987; P = .033). Of 229 studies identified, 5 retrospective reports with a total of 1375 patients were included in the analysis. The rate of reoperations for bleeding in the 5 studies ranged from 4.2% to 31.5%. Employing measures to reduce postoperative bleeding may help reduce the rate of unplanned neurosurgical reoperations 2).

Spinal reoperation

Beyond initial lesions, any form of spinal (re)operation can cause direct potential aggression to the nervous system by contact with neural tissue or by imprinting a morphological change on the neural tissue. The potential consequences of nerve root injury affect both peripheral and axial dermatomal distribution. The hypothesis of a possible neuropathic aspect associated with the back pain component of failed back surgery syndrome (FBSS) therefore appears to be reasonable. Its pathophysiology remains unclear due to the permanent interplay between nociceptive and neuropathic pain components, resulting in the coexistence of physiological and pathological pain at the same anatomical site.

Smoking was the strongest predictor of reoperation in patients who had undergone single-level laminectomy, multilevel laminectomy, or reoperation for progression of spinal degeneration. These findings suggest that tobacco smokings have worse outcomes of lumbar decompression than nonsmokers 3).

1)
Dasenbrock HH, Yan SC, Chavakula V, Gormley WB, Smith TR, Claus E, Dunn IF. 145 Unplanned Reoperation After Craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis. Neurosurgery. 2016 Aug;63 Suppl 1:159. doi: 10.1227/01.neu.0000489715.29455.af. PubMed PMID: 27399424.
2)
Zheng XR, Chen T, Yang YF, Rao W, Wang GY, Zhang SH, Fei Z. Unplanned Reoperations in Neurosurgical Patients Due to Postoperative Bleeding: A Single-Center Experience and Literature Review. Medicine (Baltimore). 2015 Jun;94(23):e739. PubMed PMID: 26061301.
3)
Bydon M, Macki M, De la Garza-Ramos R, Sciubba DM, Wolinsky JP, Gokaslan ZL, Witham TF, Bydon A. Smoking as an independent predictor of reoperation after lumbar laminectomy: a study of 500 cases. J Neurosurg Spine. 2015 Mar;22(3):288-93. doi: 10.3171/2014.10.SPINE14186. Epub 2015 Jan 2. PubMed PMID: 25555058.
reoperation.txt · Last modified: 2016/08/16 11:20 (external edit)