Susana Núñez-Pereira1, Alba Vila-Casademunt2, Montse Domingo-Sàbat2, Juan Bagó3, Emre R Acaroglu4, Ahmet Alanay5, Ibrahim Obeid6, Francisco Javier Sánchez Pérez-Grueso7, Frank Kleinstück8, Ferran Pellisé3. 1. Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Spine Surgery Department, St Franzkiskus Hospital, Schönsteinstr 63, 50825 Cologne, Germany. Electronic address: snunezpereira@gmail.com. 2. Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 3. Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Spine Surgery Unit, Hospital Universitari Vall d'Hebron, Traumatology Building, 2nd Floor, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. 4. Orthopedic Spine Unit, Ankara Spine Center, Iran Caddesi 45/2 Kavaklidere, 06700 Ankara, Turkey. 5. Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Katar cad. Kilic Sok, Istinye Park Kon, Kirlagic B Blok Daire 11, 34457 Istanbul, Turkey. 6. Spine Surgery Unit, Pellegrin University Hospital, 53 bis ave Maryse Bastié, 33520 Bruges, France. 7. Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Traumatology Building, 3er floor, Paseo de la Castellana, 261, 28046 Madrid, Spain. 8. Department of Orthopedics, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland.
Abstract
BACKGROUND CONTEXT: Revision surgery represents a major event for patients undergoing adult spinal deformity (ASD) surgery. Previous reports suggest that ASD surgery has minimal or no impact on health-related-quality of life (HRQOL) outcomes. PURPOSE: The present study aims to investigate the impact of early reoperations within the first year on HRQOL and on the likelihood of reaching the minimally clinically important difference (MCID) after ASD surgery. DESIGN: This is a retrospective analysis of prospectively collected data from consecutive surgically treated adult deformity surgery patients included in a multicenter, international database. PATIENT SAMPLE: The present study included 280 patients from a multicenter international prospective database. OUTCOME MEASURE: Oswestry Disability Index (ODI), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22), MCID were evaluated in this work. METHODS: Consecutive surgical patients with ASD recruited prospectively in six different centers from four countries with a minimum 2-year follow-up were stratified into two groups: R (revision surgery within the first year) and NR (no revision). Health-related-quality of life (ODI, SF-36, SRS-22) was assessed and compared at 6-month, 1-year, and 2-year follow-up stages. Statistical analysis included chi-square tests, Student t tests, and linear mixed models. RESULTS: Forty-three patients (R Group) received 46 revision surgeries. Nineteen patients (41.3%) had implant-related complications, 9 patients (19.6%) had deep surgical site infections, 9 patients (19.6%) had proximal junctional kyphosis, 3 patients (6.5%) had hematoma, and 6 patients (13%) had other complications. Baseline characteristics differed between groups. At 6 months, all HRQOL scores improved in both groups, except in the SF-36 Mental Component Summary and SRS-22 mental health domain in the R Group. At 1 year, ODI and SRS-22 improvement was significantly greater in the NR Group, exceeding the reported MCID. At the 2-year follow-up, ODI, SRS-22, SF-36 MCS, and SF-36 PCS improvement was similar in both groups. However, postoperative change was only above the MCID for SF-36 PCS, ODI, and SRS-22 in the NR Group. CONCLUSIONS: Early unanticipated revision surgery has a negative impact on mental health at 6 months and reduces the chances of reaching an MCID improvement in SRS-22, SF-36 PCS, and ODI at the 2-year follow-up.
BACKGROUND CONTEXT: Revision surgery represents a major event for patients undergoing adult spinal deformity (ASD) surgery. Previous reports suggest that ASD surgery has minimal or no impact on health-related-quality of life (HRQOL) outcomes. PURPOSE: The present study aims to investigate the impact of early reoperations within the first year on HRQOL and on the likelihood of reaching the minimally clinically important difference (MCID) after ASD surgery. DESIGN: This is a retrospective analysis of prospectively collected data from consecutive surgically treated adult deformity surgery patients included in a multicenter, international database. PATIENT SAMPLE: The present study included 280 patients from a multicenter international prospective database. OUTCOME MEASURE: Oswestry Disability Index (ODI), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22), MCID were evaluated in this work. METHODS: Consecutive surgical patients with ASD recruited prospectively in six different centers from four countries with a minimum 2-year follow-up were stratified into two groups: R (revision surgery within the first year) and NR (no revision). Health-related-quality of life (ODI, SF-36, SRS-22) was assessed and compared at 6-month, 1-year, and 2-year follow-up stages. Statistical analysis included chi-square tests, Student t tests, and linear mixed models. RESULTS: Forty-three patients (R Group) received 46 revision surgeries. Nineteen patients (41.3%) had implant-related complications, 9 patients (19.6%) had deep surgical site infections, 9 patients (19.6%) had proximal junctional kyphosis, 3 patients (6.5%) had hematoma, and 6 patients (13%) had other complications. Baseline characteristics differed between groups. At 6 months, all HRQOL scores improved in both groups, except in the SF-36 Mental Component Summary and SRS-22 mental health domain in the R Group. At 1 year, ODI and SRS-22 improvement was significantly greater in the NR Group, exceeding the reported MCID. At the 2-year follow-up, ODI, SRS-22, SF-36 MCS, and SF-36 PCS improvement was similar in both groups. However, postoperative change was only above the MCID for SF-36 PCS, ODI, and SRS-22 in the NR Group. CONCLUSIONS: Early unanticipated revision surgery has a negative impact on mental health at 6 months and reduces the chances of reaching an MCID improvement in SRS-22, SF-36 PCS, and ODI at the 2-year follow-up.
Authors: Susana Núñez-Pereira; Ferran Pellisé; Alba Vila-Casademunt; Ahmet Alanay; Emre Acaraglou; Ibrahim Obeid; Francisco Javier Sánchez Pérez-Grueso; Frank Kleinstück Journal: Eur Spine J Date: 2019-06-27 Impact factor: 3.134