Thirty-day unplanned reoperation following spinal surgery: how does the South African private sector measure up?

Abstract

Background: Thirty-day readmission rate and 30-day reoperation rate are recognised indicators of perioperative quality of care. While these indicators have been reported in numerous studies from developed countries, little is known about readmission and reoperation following spinal surgery in South Africa. The main aim of this study was to describe the overall rate of 30-day reoperation and 30-day readmission following spine surgery in a large open medical scheme. Secondary aims were to describe the reasons for 30-day reoperation and 30-day reoperation by spine region and for certain procedures.

Methods: This retrospective cohort study was based on an anonymised dataset of spine surgeries funded by the largest open medical scheme in South Africa between 2008 and 2017. The dataset was processed to identify descriptors of each surgery, including the year of operation, patient demographics, spinal pathology, spine region and certain procedures. The primary outcome was reoperation within 30 days, which was identified based on the time to the second operation, diagnostic codes and procedure codes.

Results: A total of 49 395 spine surgeries were included in the study, of which at least 38 218 (77%) were for degenerative pathology. Overall, 3 204 (6.5%) surgeries were associated with 30-day readmission for any cause and 415 (0.8%) patients underwent a second unplanned spine surgery within 30 days of the initial spine procedure. The most common reasons for the 415 reoperations were neural compression (n = 160, 39%) and infection (n = 79, 19%).

Conclusion: Spine surgery in the South African private sector is associated with low rates of 30-day readmission and reoperation, suggesting good quality of perioperative care. Furthermore, the findings compare favourably with those from developed countries. Future studies should investigate long-term reoperation following spinal surgery to provide more comprehensive insight into the quality of spinal surgery care in the South African private healthcare setting.

Level of evidence: Level 3