The Case for Operative Efficiency in Adult Spinal Deformity Surgery

Abstract

Study Design. Retrospective review of prospectively collected data Objective. To analyze the impact of operative room (OR) time in adult spinal deformity (ASD) surgery on patient outcomes Background. It is currently unknown if OR time in ASD patients matched for deformity severity and surgical invasiveness is associated with patient outcomes. Methods. ASD patients with baseline and 2-year postoperative radiographic and patient reported outcome measures (PROM) data, undergoing posterior only approach for long fusion (> L1- Ilium) were included. Patients were grouped into Short OR Time (<40th percentile: <359 min) and Long OR Time (>60th percentile: > 421 min). Groups were matched by age, baseline deformity severity, and surgical invasiveness. Demographics, radiographic, PROM data, fusion rate, and complications were compared between groups at baseline and 2-years follow-up. Results. In total, 270 patients were included for analysis: mean OR time was 286 minutes in the Short OR group vs 510 minutes in the Long OR group (P<0.001). Age, gender, percent of revision cases, surgical invasiveness, PI-LL, SVA and PT were comparable between groups (P>0.05). Short OR had a slightly lower BMI than the short OR group (P<0.001) and decompression was more prevalent in the long OR time (P=0.042). Patients in the Long group had greater hospital length of stay (LOS) (P=0.02); blood loss (P<0.001); proportion requiring ICU (P=0.003); higher minor complication rate (P=0.001); with no significant differences for major complications or revision procedures (P>0.5). Both groups had comparable radiographic fusion rates (P=0.152) and achieved improvement in sagittal alignment measures, ODI and SF36 (P<0.001). Conclusion. Shorter OR time for ASD correction is associated with lower minor complication rate, lower EBL, fewer ICU admissions, and shorter hospital LOS without sacrificing alignment correction or PROMS. Maximizing operative efficiency by minimizing OR time in ASD surgery has the potential to benefit patients, surgeons, and hospital systems.