Critical Analysis of Radiographic and Patient Reported Outcomes Following Anterior/Posterior Staged vs. Same Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity

Author:

Passias Peter G.1,Ahmad Waleed1,Tretiakov Peter S.1,Lafage Renaud2,Lafage Virginie2,Schoenfeld Andrew J.3,Line Breton4,Daniels Alan5,Mir Jamshaid M.1,Gupta Munish6,Mundis Gregory7,Eastlack Robert8,Nunley Pierce9,Hamilton D. Kojo10,Hostin Richard11,Hart Robert12,Burton Douglas C.13,Shaffrey Christopher14,Schwab Frank2,Ames Christopher15,Smith Justin S.16,Bess Shay4,Klineberg Eric O.17,

Affiliation:

1. Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA

2. Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA

3. Department of Orthopedic Surgery, Brigham and Women’s Center for Surgery and Public Health, Boston, MA

4. Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, CO, USA

5. Department of Orthopedics, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA

6. Department of Orthopaedic Surgery, Washington University, St. Louis, MO

7. Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, CA

8. Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA

9. Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, LA

10. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA

11. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, Texas, USA

12. Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA

13. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas

14. Department of Neurosurgery, Duke University Medical Center, Durham, NC

15. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA

16. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA

17. Department of Orthopaedic Surgery, University of California, Davis, Davis, CA

Abstract

Study-Design. Retrospective cohort study of a prospectively collected multi-center adult spinal deformity (ASD) database. Objective. To compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for treatment of ASD. Background. Surgical intervention for ASD is invasive and complex procedure that surgeons often elect to perform on different days (staging). Yet, there remains a paucity of literature on the timing and effects of the interval between stages. Methods. ASD patients with two-year (2Y) data undergoing an anterior/posterior (A/P) fusion to the ilium were included. Propensity score matching (PSM) was performed for number of levels fused, number of interbody devices, surgical approaches, number of osteotomies/three-column osteotomy (3CO), frailty, Oswestry Disability Index (ODI), Charlson Comorbidity Index (CCI), revisions, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), and UIV to create balanced cohorts of Same-Day and Staged surgical patients. Staged patients were stratified by intervening time-period between surgeries, using quartiles. Results. 176 PSM patients were included. Median interval between A/P staged procedures was 3 days. Staged patients had greater operative time and lower ICU stays postop (P<0.05). At 2Y, staged compared to same day showed a greater improvement in T1 slope – cervical lordosis (TS-CL), C2 sacral slope (C2SS), and SRS-Schwab SVA (P<0.05). Staged patients had higher rates of minimal clinically-important difference (MCID) for 1Y SRS-Appearance and 2Y physical component summary (PCS) scores. Assessing different intervals of staging, patients at the 75th percentile interval showed greater improvement in 1Y SRS Pain and Total postop as well as SRS Activity, Pain, Satisfaction, and Total scores (P<0.05) compared to patients in lower quartiles. Compared to the 25th percentile, patients reaching the 50th percentile interval were associated with increased odds of improvement in Global Alignment and Proportion (GAP) score proportionality (9.3[1.6-53.2], P=0.01). Conclusions. This investigation is among the first to compare multicenter staged and same day surgery anterior/posterior adult spinal deformity patients fused to ilium using propensity-matching. Staged procedures resulted in significant improvement radiographically, reduced ICU admissions, and superior patient reported outcomes compared to same day procedures. An interval of at least three days between staged procedures is associated with superior outcomes in terms of GAP score proportionality.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Orthopedics and Sports Medicine

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