Reasons analysis on unplanned reoperation of degenerative lumbar spine diseases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DU Ruihuan ,  LI Zhonghai

Department of Orthopedics, the First Affiliated Hospital of Dalian Medical University, Dalian Liaoning, 116600, P.R.China;

Corresponding author：

LI Zhonghai, Email: lizhonghaispine@126.com

Keywords：

Unplanned reoperation; degenerative lumbar spine disease; surgical site infection; spinal epidural hemorrhage; cerebrospinal fluid leakage

DOI：

10.7507/1002-1892.202107040

Video：

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Objective To review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. Conclusion The main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.

Citation： DU Ruihuan, LI Zhonghai. Reasons analysis on unplanned reoperation of degenerative lumbar spine diseases. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1637-1641. doi: 10.7507/1002-1892.202107040 Copy

1.	Jacobs BL, He C, Li BY, et al. Variation in readmission expenditures after high-risk surgery. J Surg Res, 2017, 213: 60-68.
2.	Li Y, Zheng S, Wu Y, et al. Trends of surgical treatment for spinal degenerative disease in China: a cohort of 37, 897 inpatients from 2003 to 2016. Clin Interv Aging, 2019, 14: 361-366.
3.	Abt NB, De la Garza-Ramos R, Olorundare IO, et al. Thirty day postoperative outcomes following anterior lumbar interbody fusion using the National Surgical Quality Improvement Program database. Clin Neurol Neurosurg, 2016, 143: 126-131.
4.	Tsai TT, Lee SH, Niu CC, et al. Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes. BMC Musculoskelet Disord, 2016, 17: 28. doi: 10.1186/s12891-016-0891-4.
5.	Liu JM, Deng HL, Peng AF, et al. Unplanned reoperation of lumbar spinal surgery during the primary admission: A multicenter study based on a large patient population. Spine (Phila Pa 1976), 2016, 41(16): 1279-1283.
6.	Shimizu T, Fujibayashi S, Takemoto M, et al. A multi-center study of reoperations within 30 days of spine surgery. Eur Spine J, 2016, 25(3): 828-835.
7.	Zhong W, Liang X, Luo X, et al. Complications rate of and risk factors for the unplanned reoperation of degenerative lumbar spondylolisthesis in elderly patients: a retrospective single-Centre cohort study of 33 patients. BMC Geriatr, 2020, 20(1): 301. doi: 10.1186/s12877-020-01717-2.
8.	Durand WM, Eltorai AEM, Depasse JM, et al. Risk Factors for unplanned reoperation within 30 days following elective posterior lumbar spinal fusion. Global Spine J, 2018, 8(4): 388-395.
9.	Yavin D, Casha S, Wiebe S, et al. Lumbar fusion for degenerative disease: A systematic review and meta-analysis. Neurosurgery, 2017, 80(5): 701-715.
10.	Plantz MA, Hsu WK. Single-level posterolateral fusion (PLF) alone and posterior interbody fusion (PLIF/TLIF) alone lead to a decreased risk of short-term complications compared to combined PLF with PLIF/TLIF procedures: A matched analysis. Spine (Phila Pa 1976), 2020, 45(21): E1391-E1399.
11.	Kim CH, Chung CK, Choi Y, et al. The long-term reoperation rate following surgery for lumbar herniated intervertebral disc disease: A nationwide sample cohort study with a 10-year follow-up. Spine (Phila Pa 1976), 2019, 44(19): 1382-1389.
12.	Aleem IS, Tan LA, Nassr A, et al. Surgical site infection prevention following spine surgery. Global Spine J, 2020, 10(1Suppl): 92S-98S.
13.	Carl HM, Ahmed AK, Abu-Bonsrah N, et al. Risk factors for wound-related reoperations in patients with metastatic spine tumor. J Neurosurg Spine, 2018, 28(6): 663-668.
14.	Gu W, Tu L, Liang Z, et al. Incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1764 instrumented spinal procedures. Am J Infect Control, 2018, 46(1): 8-13.
15.	Sebaaly A, Shedid D, Boubez G, et al. Surgical site infection in spinal metastasis: incidence and risk factors. Spine J, 2018, 18(8): 1382-1387.
16.	Zhou J, Wang R, Huo X, et al. Incidence of surgical site infection after spine surgery: A systematic review and meta-analysis. Spine (Phila Pa 1976), 2020, 45(3): 208-216.
17.	Kobayashi K, Imagama S, Ando K, et al. Trends in reoperation for surgical site infection after spinal surgery with instrumentation in a multicenter study. Spine (Phila Pa 1976), 2020, 45(20): 1459-1466.
18.	Macki M, Uzosike A, Kerezoudis P, et al. Duration of indwelling drain following instrumented posterolateral fusion of the lumbar spine does not predict surgical site infection requiring reoperation. J Clin Neurosci, 2017, 40: 44-48.
19.	De la Garza-Ramos R, Abt NB, Kerezoudis P, et al. Deep-wound and organ-space infection after surgery for degenerative spine disease: an analysis from 2006 to 2012. Neurol Res, 2016, 38(2): 117-123.
20.	Mueller K, Zhao D, Johnson O, et al. The difference in surgical site infection rates between open and minimally invasive spine surgery for degenerative lumbar pathology: A retrospective single center experience of 1442 cases. Oper Neurosurg (Hagerstown), 2019, 16(6): 750-755.
21.	Pereira BJ, de Holanda CV, Ribeiro CA, et al. Impact of body mass index in spinal surgery for degenerative lumbar spine disease. Clin Neurol Neurosurg, 2014, 127: 112-115.
22.	Takenaka S, Makino T, Sakai Y, et al. Prognostic impact of intra- and postoperative management of dural tear on postoperative complications in primary degenerative lumbar diseases. Bone Joint J, 2019, 101-B(9): 1115-1121.
23.	Hartveldt S, Janssen SJ, Wood KB, et al. Is there an association of epidural corticosteroid injection with postoperative surgical site infection after surgery for lumbar degenerative spine disease? Spine (Phila Pa 1976), 2016, 41(19): 1542-1547.
24.	Gaudiani MA, Winkelman RD, Ravishankar P, et al. The association of preoperative TNF-alpha inhibitor use and reoperation rates in spinal fusion surgery. Spine J, 2021, 21(6): 972-979.
25.	Pei H, Wang H, Chen M, et al. Surgical site infection after posterior lumbar interbody fusion and instrumentation in patients with lumbar degenerative disease. Int Wound J, 2021, 18(5): 608-615.
26.	Yao R, Zhou H, Choma TJ, et al. Surgical site infection in spine surgery: Who is at risk? Global Spine J, 2018, 8(4 Suppl): 5S-30S.
27.	Zijlmans JL, Buis DR, Verbaan D, et al. Wound drains in non-complex lumbar surgery: a systematic review. Bone Joint J, 2016, 98-B(7): 984-989.
28.	Yi S, Yoon DH, Kim KN, et al. Postoperative spinal epidural hematoma: risk factor and clinical outcome. Yonsei Med J, 2006, 47(3): 326-332.
29.	Aihara T, Endo K, Sawaji Y, et al. Five-year reoperation rates and causes for reoperations following lumbar microendoscopic discectomy and decompression. Spine (Phila Pa 1976), 2020, 45(1): 71-77.
30.	Snopko P, Opsenak R, Hanko M, et al. Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery? Bratisl Lek Listy, 2021, 122(8): 594-597.
31.	Mueller K, Altshuler M, Voyadzis JM, et al. The incidence of symptomatic postoperative epidural hematoma after minimally invasive lumbar decompression: A single institution retrospective review. Clin Neurol Neurosurg, 2020, 195: 105868. doi: 10.1016/j.clineuro.2020.105868.
32.	Khalifa AH, Stübig T, Meier O, et al. Dynamic stabilization for degenerative diseases in the lumbar spine: 2 years results. Orthop Rev (Pavia), 2018, 10(1): 7534. doi: 10.4081/or.2018.7534.
33.	Cloney M, Dhillon ES, Roberts H, et al. Predictors of readmissions and reoperations related to venous thromboembolic events after spine surgery: A single-institution experience with 6869 patients. World Neurosurg, 2018, 111: e91-e97.
34.	Wang L, Wang H, Zeng Y, et al. Delayed onset postoperative spinal epidural hematoma after lumbar spinal surgery: incidence, risk factors, and clinical outcomes. Biomed Res Int, 2020, 2020: 8827962. doi: 10.1155/2020/8827962.
35.	Hohenberger C, Zeman F, Höhne J, et al. Symptomatic postoperative spinal epidural hematoma after spinal decompression surgery: Prevalence, risk factors, and functional outcome. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(4): 290-296.
36.	Baranowska A, Baranowska J, Baranowski P. Analysis of reasons for failure of surgery for degenerative disease of lumbar spine. Ortop Traumatol Rehabil, 2016, 18(2): 117-129.
37.	Thomas JA, Thomason CIM, Braly BA, et al. Rate of failure of indirect decompression in lateral single-position surgery: clinical results. Neurosurg Focus, 2020, 49(3): E5. doi: 10.3171/2020.6.FOCUS20375.
38.	Kukreja S, Kalakoti P, Ahmed O, et al. Predictors of reoperation-free survival following decompression-alone lumbar spine surgery for on-the-job injuries. Clin Neurol Neurosurg, 2015, 135: 41-45.
39.	Kim SK, Park SW, Lim BC, et al. Comparison of reoperation after fusion and after decompression for degenerative lumbar spinal stenosis: A single-center experience of 987 cases. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(5): 392-398.
40.	Gandhi J, DiMatteo A, Joshi G, et al. Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management. Int J Neurosci, 2021, 131(7): 689-695.
41.	Durand WM, DePasse JM, Kuris EO, et al. Late-presenting dural tear: incidence, risk factors, and associated complications. Spine J, 2018, 18(11): 2043-2050.
42.	Deukmedjian AJ, Cianciabella AJ, Cutright J, et al. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain. J Craniovertebr Junction Spine, 2015, 6(4): 183-189.
43.	Hall JF, McLean JB, Jones SM, et al. Multilevel instrumented posterolateral lumbar spine fusion with an allogeneic cellular bone graft. J Orthop Surg Res, 2019, 14(1): 372. doi: 10.1186/s13018-019-1424-2.
44.	Bydon M, Macki M, Abt NB, et al. Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients. Surg Neurol Int, 2015, 6(Suppl4): S190-193.
45.	Weiss H, Garcia RM, Hopkins B, et al. A systematic review of complications following minimally invasive spine surgery including transforaminal lumbar interbody fusion. Curr Rev Musculoskelet Med, 2019, 12(3): 328-339.
46.	Ghobrial GM, Williams KA, Arnold P, et al. Iatrogenic neurologic deficit after lumbar spine surgery: A review. Clin Neurol Neurosurg, 2015, 139: 76-80.
47.	Šámal F, Linzer P, Filip M, et al. Minimally invasive posterior lumbar interbody fusion and instrumentation-outcomes at 24-month follow-up. Acta Chir Orthop Traumatol Cech, 2020, 87(2): 95-100.
48.	Janssen I, Ryang YM, Gempt J, et al. Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. Spine J, 2017, 17(6): 837-844.
49.	Lee CH, Kim CH, Chung CK, et al. Long-term effect of diabetes on reoperation after lumbar spinal surgery: A nationwide population-based sample cohort study. World Neurosurg, 2020, 139: e439-e448.
50.	Khalid SI, Nunna RS, Maasarani S, et al. Association of osteopenia and osteoporosis with higher rates of pseudarthrosis and revision surgery in adult patients undergoing single-level lumbar fusion. Neurosurg Focus, 2020, 49(2): E6. doi: 10.3171/2020.5.FOCUS20289.

1. Jacobs BL, He C, Li BY, et al. Variation in readmission expenditures after high-risk surgery. J Surg Res, 2017, 213: 60-68.
2. Li Y, Zheng S, Wu Y, et al. Trends of surgical treatment for spinal degenerative disease in China: a cohort of 37, 897 inpatients from 2003 to 2016. Clin Interv Aging, 2019, 14: 361-366.
3. Abt NB, De la Garza-Ramos R, Olorundare IO, et al. Thirty day postoperative outcomes following anterior lumbar interbody fusion using the National Surgical Quality Improvement Program database. Clin Neurol Neurosurg, 2016, 143: 126-131.
4. Tsai TT, Lee SH, Niu CC, et al. Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes. BMC Musculoskelet Disord, 2016, 17: 28. doi: 10.1186/s12891-016-0891-4.
5. Liu JM, Deng HL, Peng AF, et al. Unplanned reoperation of lumbar spinal surgery during the primary admission: A multicenter study based on a large patient population. Spine (Phila Pa 1976), 2016, 41(16): 1279-1283.
6. Shimizu T, Fujibayashi S, Takemoto M, et al. A multi-center study of reoperations within 30 days of spine surgery. Eur Spine J, 2016, 25(3): 828-835.
7. Zhong W, Liang X, Luo X, et al. Complications rate of and risk factors for the unplanned reoperation of degenerative lumbar spondylolisthesis in elderly patients: a retrospective single-Centre cohort study of 33 patients. BMC Geriatr, 2020, 20(1): 301. doi: 10.1186/s12877-020-01717-2.
8. Durand WM, Eltorai AEM, Depasse JM, et al. Risk Factors for unplanned reoperation within 30 days following elective posterior lumbar spinal fusion. Global Spine J, 2018, 8(4): 388-395.
9. Yavin D, Casha S, Wiebe S, et al. Lumbar fusion for degenerative disease: A systematic review and meta-analysis. Neurosurgery, 2017, 80(5): 701-715.
10. Plantz MA, Hsu WK. Single-level posterolateral fusion (PLF) alone and posterior interbody fusion (PLIF/TLIF) alone lead to a decreased risk of short-term complications compared to combined PLF with PLIF/TLIF procedures: A matched analysis. Spine (Phila Pa 1976), 2020, 45(21): E1391-E1399.
11. Kim CH, Chung CK, Choi Y, et al. The long-term reoperation rate following surgery for lumbar herniated intervertebral disc disease: A nationwide sample cohort study with a 10-year follow-up. Spine (Phila Pa 1976), 2019, 44(19): 1382-1389.
12. Aleem IS, Tan LA, Nassr A, et al. Surgical site infection prevention following spine surgery. Global Spine J, 2020, 10(1Suppl): 92S-98S.
13. Carl HM, Ahmed AK, Abu-Bonsrah N, et al. Risk factors for wound-related reoperations in patients with metastatic spine tumor. J Neurosurg Spine, 2018, 28(6): 663-668.
14. Gu W, Tu L, Liang Z, et al. Incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1764 instrumented spinal procedures. Am J Infect Control, 2018, 46(1): 8-13.
15. Sebaaly A, Shedid D, Boubez G, et al. Surgical site infection in spinal metastasis: incidence and risk factors. Spine J, 2018, 18(8): 1382-1387.
16. Zhou J, Wang R, Huo X, et al. Incidence of surgical site infection after spine surgery: A systematic review and meta-analysis. Spine (Phila Pa 1976), 2020, 45(3): 208-216.
17. Kobayashi K, Imagama S, Ando K, et al. Trends in reoperation for surgical site infection after spinal surgery with instrumentation in a multicenter study. Spine (Phila Pa 1976), 2020, 45(20): 1459-1466.
18. Macki M, Uzosike A, Kerezoudis P, et al. Duration of indwelling drain following instrumented posterolateral fusion of the lumbar spine does not predict surgical site infection requiring reoperation. J Clin Neurosci, 2017, 40: 44-48.
19. De la Garza-Ramos R, Abt NB, Kerezoudis P, et al. Deep-wound and organ-space infection after surgery for degenerative spine disease: an analysis from 2006 to 2012. Neurol Res, 2016, 38(2): 117-123.
20. Mueller K, Zhao D, Johnson O, et al. The difference in surgical site infection rates between open and minimally invasive spine surgery for degenerative lumbar pathology: A retrospective single center experience of 1442 cases. Oper Neurosurg (Hagerstown), 2019, 16(6): 750-755.
21. Pereira BJ, de Holanda CV, Ribeiro CA, et al. Impact of body mass index in spinal surgery for degenerative lumbar spine disease. Clin Neurol Neurosurg, 2014, 127: 112-115.
22. Takenaka S, Makino T, Sakai Y, et al. Prognostic impact of intra- and postoperative management of dural tear on postoperative complications in primary degenerative lumbar diseases. Bone Joint J, 2019, 101-B(9): 1115-1121.
23. Hartveldt S, Janssen SJ, Wood KB, et al. Is there an association of epidural corticosteroid injection with postoperative surgical site infection after surgery for lumbar degenerative spine disease? Spine (Phila Pa 1976), 2016, 41(19): 1542-1547.
24. Gaudiani MA, Winkelman RD, Ravishankar P, et al. The association of preoperative TNF-alpha inhibitor use and reoperation rates in spinal fusion surgery. Spine J, 2021, 21(6): 972-979.
25. Pei H, Wang H, Chen M, et al. Surgical site infection after posterior lumbar interbody fusion and instrumentation in patients with lumbar degenerative disease. Int Wound J, 2021, 18(5): 608-615.
26. Yao R, Zhou H, Choma TJ, et al. Surgical site infection in spine surgery: Who is at risk? Global Spine J, 2018, 8(4 Suppl): 5S-30S.
27. Zijlmans JL, Buis DR, Verbaan D, et al. Wound drains in non-complex lumbar surgery: a systematic review. Bone Joint J, 2016, 98-B(7): 984-989.
28. Yi S, Yoon DH, Kim KN, et al. Postoperative spinal epidural hematoma: risk factor and clinical outcome. Yonsei Med J, 2006, 47(3): 326-332.
29. Aihara T, Endo K, Sawaji Y, et al. Five-year reoperation rates and causes for reoperations following lumbar microendoscopic discectomy and decompression. Spine (Phila Pa 1976), 2020, 45(1): 71-77.
30. Snopko P, Opsenak R, Hanko M, et al. Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery? Bratisl Lek Listy, 2021, 122(8): 594-597.
31. Mueller K, Altshuler M, Voyadzis JM, et al. The incidence of symptomatic postoperative epidural hematoma after minimally invasive lumbar decompression: A single institution retrospective review. Clin Neurol Neurosurg, 2020, 195: 105868. doi: 10.1016/j.clineuro.2020.105868.
32. Khalifa AH, Stübig T, Meier O, et al. Dynamic stabilization for degenerative diseases in the lumbar spine: 2 years results. Orthop Rev (Pavia), 2018, 10(1): 7534. doi: 10.4081/or.2018.7534.
33. Cloney M, Dhillon ES, Roberts H, et al. Predictors of readmissions and reoperations related to venous thromboembolic events after spine surgery: A single-institution experience with 6869 patients. World Neurosurg, 2018, 111: e91-e97.
34. Wang L, Wang H, Zeng Y, et al. Delayed onset postoperative spinal epidural hematoma after lumbar spinal surgery: incidence, risk factors, and clinical outcomes. Biomed Res Int, 2020, 2020: 8827962. doi: 10.1155/2020/8827962.
35. Hohenberger C, Zeman F, Höhne J, et al. Symptomatic postoperative spinal epidural hematoma after spinal decompression surgery: Prevalence, risk factors, and functional outcome. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(4): 290-296.
36. Baranowska A, Baranowska J, Baranowski P. Analysis of reasons for failure of surgery for degenerative disease of lumbar spine. Ortop Traumatol Rehabil, 2016, 18(2): 117-129.
37. Thomas JA, Thomason CIM, Braly BA, et al. Rate of failure of indirect decompression in lateral single-position surgery: clinical results. Neurosurg Focus, 2020, 49(3): E5. doi: 10.3171/2020.6.FOCUS20375.
38. Kukreja S, Kalakoti P, Ahmed O, et al. Predictors of reoperation-free survival following decompression-alone lumbar spine surgery for on-the-job injuries. Clin Neurol Neurosurg, 2015, 135: 41-45.
39. Kim SK, Park SW, Lim BC, et al. Comparison of reoperation after fusion and after decompression for degenerative lumbar spinal stenosis: A single-center experience of 987 cases. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(5): 392-398.
40. Gandhi J, DiMatteo A, Joshi G, et al. Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management. Int J Neurosci, 2021, 131(7): 689-695.
41. Durand WM, DePasse JM, Kuris EO, et al. Late-presenting dural tear: incidence, risk factors, and associated complications. Spine J, 2018, 18(11): 2043-2050.
42. Deukmedjian AJ, Cianciabella AJ, Cutright J, et al. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain. J Craniovertebr Junction Spine, 2015, 6(4): 183-189.
43. Hall JF, McLean JB, Jones SM, et al. Multilevel instrumented posterolateral lumbar spine fusion with an allogeneic cellular bone graft. J Orthop Surg Res, 2019, 14(1): 372. doi: 10.1186/s13018-019-1424-2.
44. Bydon M, Macki M, Abt NB, et al. Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients. Surg Neurol Int, 2015, 6(Suppl4): S190-193.
45. Weiss H, Garcia RM, Hopkins B, et al. A systematic review of complications following minimally invasive spine surgery including transforaminal lumbar interbody fusion. Curr Rev Musculoskelet Med, 2019, 12(3): 328-339.
46. Ghobrial GM, Williams KA, Arnold P, et al. Iatrogenic neurologic deficit after lumbar spine surgery: A review. Clin Neurol Neurosurg, 2015, 139: 76-80.
47. Šámal F, Linzer P, Filip M, et al. Minimally invasive posterior lumbar interbody fusion and instrumentation-outcomes at 24-month follow-up. Acta Chir Orthop Traumatol Cech, 2020, 87(2): 95-100.
48. Janssen I, Ryang YM, Gempt J, et al. Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. Spine J, 2017, 17(6): 837-844.
49. Lee CH, Kim CH, Chung CK, et al. Long-term effect of diabetes on reoperation after lumbar spinal surgery: A nationwide population-based sample cohort study. World Neurosurg, 2020, 139: e439-e448.
50. Khalid SI, Nunna RS, Maasarani S, et al. Association of osteopenia and osteoporosis with higher rates of pseudarthrosis and revision surgery in adult patients undergoing single-level lumbar fusion. Neurosurg Focus, 2020, 49(2): E6. doi: 10.3171/2020.5.FOCUS20289.

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