The incidence, causes, risk factors, and predictive nomogram of 30-day unplanned reoperation after spinal surgery: a multi-center retrospective study.

Incidence and predictors of early and late reoperation after primary lumbar spine fusion: a 10-year retrospective cohort study of 1,356 patients.

Incidence and factors influencing the occurrence of postoperative thrombosis in patients with lower limb fractures across different age groups: a retrospective study

Abstract Background Postoperative venous thrombosis (PVT) is a common complication following lower limb fracture surgery, yet age-specific risk factors remain unclear. This study aimed to identify distinct predictors and develop tailored prediction models for young/middle-aged and elderly patients. Patients and methods This multicentre retrospective cohort study analysed factors influencing of PVT in 483 patients undergoing lower limb fracture surgery at two tertiary hospitals between 1 January 2020 and 31 December 2022. Participants were divided into young/middle-aged (18–59 years, n = 269) and elderly (≥60 years, n = 214) groups for stratified analysis. Comprehensive perioperative variables were analysed. PVT was diagnosed via ultrasound within seven days postoperatively. Age-specific predictors were identified using multivariable logistic regression, and nomogram models were subsequently developed. Model performance was evaluated through the area under the curve (AUC). Results The overall PVT incidence was 15.24% and 23.36% (p < 0.05) in young/middle-aged and elderly patients, respectively. Predictive of postoperative thrombosis among the young/middle aged population were intraoperative colloid infusion rate (OR = 0.784, 95% CI: 0.667–0.921), preoperative prothrombin time activity (OR = 0.947, 95% CI: 0.913–0.982) and postoperative anticoagulant use (OR = 7.117, 95% CI: 2.062–24.560) and among the elderly group were total intraoperative crystalloids (OR = 1.001, 95% CI: 1.000–1.001) and colloid infusion rate (OR = 1.101, 95% CI: 1.104–1.208), postoperative total protein (OR = 0.937, 95% CI: 0.886–0.990) and serum sodium (OR = 0.918, 95% CI: 0.848–0.994). The AUC and total score points for young/middle-aged group model was 0.760 and 204 points, and 0.750 and 116 points among the elderly. Conclusions Fracture patients of different age groups require distinct risk management and perioperative treatments. This study developed age-specific PVT prediction models, highlighting the different risk profiles between young/middle-aged and elderly patients. For young/middle-aged patients, preoperative coagulation status should be optimized, postoperative anticoagulant overuse limited and fluid volume recovery enhanced. For elderly patients, intraoperative fluid input should be strictly restricted, and postoperative protein and electrolyte levels monitored.

The utility of the Risk Assessment and Prediction Tool in predicting discharge disposition, length of stay, and readmissions in patients undergoing transforaminal lumbar interbody fusion.

OBJECTIVE The Risk Assessment and Prediction Tool (RAPT) has been utilized to anticipate discharge needs after procedures such as total joint arthroplasty. Its usefulness for spine patients, particularly those undergoing transforaminal lumbar interbody fusion (TLIF), has not been clearly established. This study evaluated the relationship between the preoperative RAPT score and 3 postoperative outcomes: discharge destination, hospital length of stay (LOS), and 30-day readmission. METHODS A retrospective cohort study was conducted of adults who underwent elective TLIF with a recorded preoperative RAPT score. RAPT was analyzed as a continuous variable. Home discharge and 30-day readmission were modeled with logistic regression, and LOS with linear regression. Multivariable models adjusted for age, sex, Charlson Comorbidity Index (CCI), and insurance type. Discrimination for facility discharge was assessed by receiver operating characteristic (ROC) analysis at literature-aligned thresholds (RAPT scores 9.5 and 8.5: balanced and conservative, respectively). RESULTS Among 116 patients, the mean age was 62.2 years and 50.9% of patients were female; the mean BMI was 29.9, and the mean CCI was 5.64. The mean RAPT score was 9.65, and the mean LOS was 3.14 days. Discharge to a skilled nursing or rehabilitation facility occurred in 6.9% of patients, and 30-day readmission occurred in 6.0%. Each 1-point increase in the RAPT score was associated with higher odds of home discharge (univariate: OR 1.74, 95% CI 1.11-2.73, p = 0.016; multivariable: OR 2.17, 95% CI 1.24-3.80, p = 0.007) and a shorter LOS (β = -0.38 days, 95% CI -0.71 to -0.05, p = 0.025; adjusted β = -0.39, bootstrap 95% CI -0.76 to -0.10, p = 0.038). The RAPT score was not associated with 30-day readmission (adjusted OR 0.93, 95% CI 0.52-1.65; p = 0.798). ROC analysis for predicting facility discharge showed moderate discrimination with an area under the curve of 0.709 (95% CI 0.543-0.876, p = 0.049), with sensitivity 63% and specificity 62% at 9.5, and sensitivity 38% and specificity 82% at 8.5. Youden's index revealed an optimal cutoff of 10.5, with sensitivity 100% and specificity 29.6%. CONCLUSIONS In patients undergoing TLIF, higher preoperative RAPT scores were associated with greater odds of home discharge and shorter LOS. RAPT may serve as a practical preoperative tool to support discharge planning and resource allocation in spine surgery.

Factors Associated With Reoperation After Minimally Invasive Tubular Transforaminal Lumbar Interbody Fusion: A Cohort Study of 756 Patients

Study Design Retrospective Cohort Study using Nested Matched Case-Control Analysis. Objectives High-volume data to describe the complication profile and factors associated with reoperation after minimally invasive tubular transforaminal lumbar interbody fusions (TLIFs) in the short-term (<30 days) and long-term (>30 days). Methods All tubular TLIFs (2011-2024) were retrospectively reviewed, performed by eight neurosurgeons at our single centre. Two matched controls per reoperation case were manually selected. Each control had undergone the same primary procedure within six months of the index case, at the same levels and, if possible, by the same surgeon. Variables included demographics, comorbidities, frailty indices, private/public status, workplace injury, preoperative antithrombotics, preoperative laboratory results, the symptomatic indications, surgical factors, and clinical outcomes. Univariate logistic regression identified candidate variables for multivariate analysis. Results From 756 patients, there was a 6.6% reoperation rate (n=50), with mean follow-up of 1.5 (±1.7) years. Short-term reoperation was predominantly for cage migration and multivariate analysis revealed no independent predictors. Long-term reoperation was mainly for cage migration and was associated with private-funding, WorkCover status, osteoporosis/osteopenia, and previous lumbar surgery. Combined timeframe reoperations were associated with WorkCover status, osteoporosis/osteopenia, diabetes, and previous lumbar surgery. Patients who had reoperations fared worse than their matched controls. Additionally, a worse patient outcome was associated with diabetes, a higher Modified Charlson Comorbidity Index, and previous lumbar surgery. Conclusion This retrospective case-control series reports our complication profile and factors associated with reoperation and poor patient outcomes after tubular TLIFs. Reoperation was associated with osteoporosis/osteopenia, diabetes, private-funding, WorkCover status, and previous lumbar surgery at another spinal level.

Early Postoperative Adverse Events (≤ 30 Days) in Spinal Oncology: Defining the Incidence, Severity, and Predictors in a Mixed Prospective Cohort Including Intradural and Metastatic Spinal Tumors.

Complication reporting in spinal tumor surgery remains inconsistently defined. We aimed to quantify the incidence, severity, and spectrum of early (≤ 30 days) postoperative adverse events (AEs) in spinal tumor surgery and to identify predictors of overall and serious complications using standardized severity grading. We analyzed prospective data from 156 patients undergoing spinal tumor surgery for mixed primary and metastatic pathologies between 2023 and 2025. Intra- and extradural lesions were included. AEs were classified according to the Clavien-Dindo system, and risk factors were identified using logistic regression. The age-adjusted Charlson comorbidity index (ACCI) was used to assess comorbidity burden. Any postoperative AE occurred in 16.7% of cases, and serious complications (Clavien-Dindo ≥ III) occurred in 7.1%. Surgery-related events predominated (14.7%). Stratified analysis revealed differences between tumor subgroups, with the highest complication rates observed in intramedullary tumors, primarily driven by neurological deficits. The ACCI was the strongest predictor of both overall (p = 0.006) and serious complications (p = 0.001), corresponding to a 20%-39% risk increase per point. Emergency surgery and advanced age were associated with serious complications, while operative duration correlated modestly with overall AEs. Mortality within 30 days was 1.9%. AEs were dominated by neurological and surgery-related complications. Complication profiles differed according to tumor location, reflecting underlying surgical and biological differences. Comorbidity burden and urgency emerged as predictors for AEs in general. These findings underscore the need for structured preoperative risk stratification, timely elective referral, and standardized AE reporting to improve safety and comparability across spinal tumor surgery studies.

The revised cardiac risk index and 90-day mortality after non-cardiac surgery: a retrospective cohort study

Background The Revised Cardiac Risk Index (RCRI) is widely used for predicting major cardiac complications after non-cardiac surgery, but its association with 90-day all-cause mortality is less well established. This study aimed to evaluate the independent association between RCRI scores and 90-day all-cause mortality in a large, diverse cohort of patients undergoing non-cardiac surgery. Methods We conducted a retrospective cohort study using data from 54,933 adult patients who underwent non-cardiac surgery at a tertiary care center in Singapore between 2012 and 2016. RCRI scores were calculated based on six clinical variables and categorized into four classes. The primary outcome was 90-day all-cause mortality. Survival analysis was performed using Kaplan–Meier curves and multivariable Cox proportional hazards models, with adjustments for demographic and clinical covariates. Results A total of 735 patients (1.3%) died within 90 days postoperatively. Kaplan–Meier analysis revealed significantly poorer survival in higher RCRI classes (log-rank p < 0.001). In the fully adjusted model, compared to RCRI Class I, the hazard ratios for 90-day mortality were 1.97 (95% CI: 1.54–2.52) for Class II, 1.93 (95% CI: 1.45–2.58) for Class III, and 3.08 (95% CI: 2.29–4.15) for Class IV (p for trend <0.001). Subgroup analyses confirmed consistent associations across age, sex, ASA class, and surgical priority groups. Conclusion Higher RCRI scores are independently associated with increased 90-day mortality after non-cardiac surgery, demonstrating a clear dose–response relationship. These findings support the use of RCRI as a practical and effective tool for preoperative risk stratification in diverse surgical populations.