STUDY DESIGN: Retrospective review of a prospectively collected database. OBJECTIVE: This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary versus revision adult spinal deformity surgery SUMMARY OF BACKGROUND DATA.: Although adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary versus revision spinal deformity surgery comparatively. METHODS: Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity, and procedure-related complications incidence were determined for primary versus revision cohorts. Multivariate analysis reported as (OR [95% CI]). RESULTS: Discharges for 9133 primary and 850 revision cases were identified. Patients differed on the basis of demographic and hospital data. Average comorbidity indices for the cohorts were similar (P = 0.580), as was in-hospital mortality (P = 0.163). The incidence of procedure-related complications was higher for the revision cohort (46.96 % vs. 71.97%, P = 0.001). The mean hospital course for the revision cohort was longer (6.37 vs. 7.13 days, P < 0.0001). Revisions had an increased risk of complications involving the nervous system (1.34[1.10-1.6]), hematoma/seroma formation (2.31[1.92-2.78]), accidental vessel or nerve puncture (1.44[1.29-1.61]), wound dehiscence (2.18[1.48-3.21]), postop infection (3.10[2.50-3.85]), and ARDS complications (1.43[1.28-1.60]). The primary cohort had a decreased risk for GI (0.65[0.55-0.76]) and GU complications (0.71[0.51-0.99]). CONCLUSION: Relative to primary cases, those undergoing revision correction of spinal deformity have a higher risk of many procedure-related complications with a longer hospital course despite similar baseline comorbidity burden and the in-hospital mortality rate. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality and direct future research to improve outcomes.
STUDY DESIGN: Retrospective review of a prospectively collected database. OBJECTIVE: This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary versus revision adult spinal deformity surgery SUMMARY OF BACKGROUND DATA.: Although adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary versus revision spinal deformity surgery comparatively. METHODS: Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity, and procedure-related complications incidence were determined for primary versus revision cohorts. Multivariate analysis reported as (OR [95% CI]). RESULTS: Discharges for 9133 primary and 850 revision cases were identified. Patients differed on the basis of demographic and hospital data. Average comorbidity indices for the cohorts were similar (P = 0.580), as was in-hospital mortality (P = 0.163). The incidence of procedure-related complications was higher for the revision cohort (46.96 % vs. 71.97%, P = 0.001). The mean hospital course for the revision cohort was longer (6.37 vs. 7.13 days, P < 0.0001). Revisions had an increased risk of complications involving the nervous system (1.34[1.10-1.6]), hematoma/seroma formation (2.31[1.92-2.78]), accidental vessel or nerve puncture (1.44[1.29-1.61]), wound dehiscence (2.18[1.48-3.21]), postop infection (3.10[2.50-3.85]), and ARDS complications (1.43[1.28-1.60]). The primary cohort had a decreased risk for GI (0.65[0.55-0.76]) and GU complications (0.71[0.51-0.99]). CONCLUSION: Relative to primary cases, those undergoing revision correction of spinal deformity have a higher risk of many procedure-related complications with a longer hospital course despite similar baseline comorbidity burden and the in-hospital mortality rate. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality and direct future research to improve outcomes.
Authors: Mitsuru Yagi; Christopher P Ames; Malla Keefe; Naobumi Hosogane; Justin S Smith; Christopher I Shaffrey; Frank Schwab; Virginie Lafage; R Shay Bess; Morio Matsumoto; Kota Watanabe Journal: Eur Spine J Date: 2017-08-23 Impact factor: 3.134
Authors: Jeffrey M Hills; S Tim Yoon; John M Rhee; Dheera Ananthakrishnan; Elliot Kim; Keith W Michael; Byron Stephens Journal: Int J Spine Surg Date: 2019-04-30
Authors: Gregory W Poorman; Peter L Zhou; Dennis Vasquez-Montes; Samantha Horn; Cole Bortz; Frank Segreto; Joshua Auerbach; John Y Moon; Jared C Tishelman; Michael C Gerling; Bassel G Diebo; Rafael De La Garza-Ramos; Justin C Paul; Peter G Passias Journal: J Spine Surg Date: 2018-06
Authors: Rafael DE LA Garza Ramos; Jonathan Nakhla; Niketh Bhashyam; Adam E Ammar; Aleka N Scoco; Merrit D Kinon; Reza Yassari Journal: Int J Spine Surg Date: 2018-08-31