Peter G Passias1, Eric O Klineberg2, Cyrus M Jalai1, Nancy Worley1, Gregory W Poorman1, Breton Line3, Cheongeun Oh1, Douglas C Burton4, Han Jo Kim5, Daniel M Sciubba6, D Kojo Hamilton7, Christopher P Ames8, Justin S Smith9, Christopher I Shaffrey9, Virginie Lafage5, Shay Bess3. 1. Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY. 2. Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA. 3. Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, CO. 4. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS. 5. Department of Orthopaedics, Hospital for Special Surgery, New York, NY. 6. Department of Neurosurgery, The Johns Hopkins University, Baltimore, MD. 7. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. 8. Department of Neurosurgery, University of California San Francisco, San Francisco, CA. 9. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA.
Abstract
STUDY DESIGN: A retrospective review of prospective multicenter database. OBJECTIVE: The aim of this study was to identify factors influencing readmission, reoperation, and the impact on health-related quality of life outcomes (HRQoLs) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Many ASD patients experience complications requiring readmission. It is important to identify baseline/operative factors leading to rehospitalizations and reoperation, which may impact outcomes. INCLUSION CRITERIA: ASD surgical patients (age >18 yrs, major coronal Cobb ≥20°, sagittal vertical axis ≥5 cm, pelvic tilt ≥25°, and/or thoracic kyphosis >60°) with complete baseline, 1-, and 2-year follow-up. Patients were grouped on the basis of readmission occurrence (yes/no) and type [medical (no reoperation) vs. surgical (revision surgery)]. Readmissions caused by infections requiring surgical treatment (e.g., deep infections) were considered reoperations. Univariate and multivariate analyses determined readmission and reoperation predictors. Repeated measures mixed models evaluated readmission impact on HRQoLs at 1 and 2 years. RESULTS: Three hundred thirty-four patients were included: 76 (22.8%) readmissions, involving 65 (85.5% of 76) reoperations (surgical readmission) and 11 (14.5% of 76) medical readmissions. The most common surgical readmission indication (n = 65) was implant complications (36.9%; rod breakage n = 13); the most common medical readmission indication was infection (36.4%, n = 4), treated with antibiotics. Noninfectious medical readmission (n = 7) included pleural effusion, deep vein thrombosis (DVT), intraoperative blood loss, neurologic, and unspecified. Readmission predictors: increased number of major peri-operative complications [odds ratio (OR) 5.13, P = 0.014], infection presence (OR 25.02, P = 0.001), implant complications (OR 6.12, P < 0.001), and radiographic complications (DJK, proximal junctional kyphosis, pseudoarthrosis, sagittal/coronal imbalance) (OR 16.94, P < 0.001). HRQoL analysis revealed overall improvement of the full cohort (P < 0.01), though the 76 readmitted improved less overall and at each time point P < 0.001) except in 6-week MCS (P = 0.14). CONCLUSION: Major peri-operative, implant, radiographic, and infection complications during index were associated with increased readmission odds. Implant complications most frequently caused surgical readmissions. Readmitted patients improved in outcome scores, although less compared with the nonreadmitted cohort, yet displayed reduced 6-week SF-36 Mental Component Summary. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: A retrospective review of prospective multicenter database. OBJECTIVE: The aim of this study was to identify factors influencing readmission, reoperation, and the impact on health-related quality of life outcomes (HRQoLs) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Many ASDpatients experience complications requiring readmission. It is important to identify baseline/operative factors leading to rehospitalizations and reoperation, which may impact outcomes. INCLUSION CRITERIA: ASD surgical patients (age >18 yrs, major coronal Cobb ≥20°, sagittal vertical axis ≥5 cm, pelvic tilt ≥25°, and/or thoracic kyphosis >60°) with complete baseline, 1-, and 2-year follow-up. Patients were grouped on the basis of readmission occurrence (yes/no) and type [medical (no reoperation) vs. surgical (revision surgery)]. Readmissions caused by infections requiring surgical treatment (e.g., deep infections) were considered reoperations. Univariate and multivariate analyses determined readmission and reoperation predictors. Repeated measures mixed models evaluated readmission impact on HRQoLs at 1 and 2 years. RESULTS: Three hundred thirty-four patients were included: 76 (22.8%) readmissions, involving 65 (85.5% of 76) reoperations (surgical readmission) and 11 (14.5% of 76) medical readmissions. The most common surgical readmission indication (n = 65) was implant complications (36.9%; rod breakage n = 13); the most common medical readmission indication was infection (36.4%, n = 4), treated with antibiotics. Noninfectious medical readmission (n = 7) included pleural effusion, deep vein thrombosis (DVT), intraoperative blood loss, neurologic, and unspecified. Readmission predictors: increased number of major peri-operative complications [odds ratio (OR) 5.13, P = 0.014], infection presence (OR 25.02, P = 0.001), implant complications (OR 6.12, P < 0.001), and radiographic complications (DJK, proximal junctional kyphosis, pseudoarthrosis, sagittal/coronal imbalance) (OR 16.94, P < 0.001). HRQoL analysis revealed overall improvement of the full cohort (P < 0.01), though the 76 readmitted improved less overall and at each time point P < 0.001) except in 6-week MCS (P = 0.14). CONCLUSION: Major peri-operative, implant, radiographic, and infection complications during index were associated with increased readmission odds. Implant complications most frequently caused surgical readmissions. Readmitted patients improved in outcome scores, although less compared with the nonreadmitted cohort, yet displayed reduced 6-week SF-36 Mental Component Summary. LEVEL OF EVIDENCE: 3.
Authors: Peter G Passias; Cole A Bortz; Katherine E Pierce; Haddy Alas; Avery Brown; Dennis Vasquez-Montes; Sara Naessig; Waleed Ahmad; Bassel G Diebo; Tina Raman; Themistocles S Protopsaltis; Aaron J Buckland; Michael C Gerling; Renaud Lafage; Virginie Lafage Journal: Int J Spine Surg Date: 2020-12
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