Alan H Daniels1, Shay Bess2, Breton Line2, Adam E M Eltorai1, Daniel B C Reid3, Virginie Lafage4, Behrooz A Akbarnia5, Christopher P Ames6, Oheneba Boachie-Adjei4, Douglas C Burton7, Vedat Deviren8, Han Jo Kim4, Robert A Hart9, Khaled M Kebaish10, Eric O Klineberg11, Munish Gupta12, Gregory M Mundis5, Richard A Hostin13, Michael O'Brien13, Frank J Schwab4, Christopher I Shaffrey14, Justin S Smith14. 1. Department of Orthopedics, Brown University, Providence, Rhode Island, USA. 2. Department of Orthopedics, Denver International Spine Center, Presbyterian/St. Luke's, Rocky Mountain Hospital for Children, Denver, Colorado, USA. 3. Department of Orthopedics, Brown University, Providence, Rhode Island, USA. Electronic address: danreid123@gmail.com. 4. Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA. 5. San Diego Center for Spinal Disorders, San Diego, California, USA. 6. Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA. 7. Department of Orthopedics, University of Kansas Hospital, Kansas City, Kansas, USA. 8. Department of Orthopedics, University of California, San Francisco, San Francisco, California, USA. 9. Department of Orthopedics, Swedish Medical Center, Seattle, Washington, USA. 10. Department of Orthopedics, Johns Hopkins University, Baltimore, Maryland, USA. 11. Department of Orthopedics, University of California, Davis, Davis, California, USA. 12. Department of Orthopedics, Washington University in St. Louis, St. Louis, Missouri, USA. 13. Baylor Scoliosis Center, Plano, Texas, USA. 14. Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Abstract
BACKGROUND: Overall complication rates for adult spinal deformity (ASD) surgery have been reported; however, little data exist on the peak timing associated with specific complications. This study quantifies the peak timing for multiple complication types in an ASD cohort at minimum 2-year follow-up. METHODS: Multicenter, prospective analysis of all complications after ASD surgery in a consecutively enrolled cohort was performed. Inclusion criteria were ASD, age ≥18 years, spinal fusion ≥4 levels, and minimum 2-year follow-up. Complications included major and minor and specific complication types. Peak timing of specific complications was identified and described. Regression analysis was performed to assess correlation between patient/surgical factors and complication timing. RESULTS: There were 280 patients who met the inclusion criteria. Mean follow-up time was 2.9 years (range, 2-5 years). Of the patients, 209 (74.6%) had at least 1 complication, accounting for 529 total complications (258 minor and 271 major). Both major and minor complications peaked at <3 months. Infection and neurologic complications peaked at <3 months. Proximal junctional kyphosis had bimodal peaks at <3 and >24 months. Implant failure peaked at 12-24 and >24 months. There was a significant positive correlation between preoperative sagittal vertical axis and total complications at 6-12 months, major complications at 24 months, and reoperation. Body mass index was associated with total complications and implant failure at 12-24 and >24 months. CONCLUSIONS: The peak timing of specific complications after ASD surgery is identifiable. Understanding when these complications are likely to occur may improve patient counseling, early diagnosis, and prophylactic interventions and may help inform future reimbursement models.
BACKGROUND: Overall complication rates for adult spinal deformity (ASD) surgery have been reported; however, little data exist on the peak timing associated with specific complications. This study quantifies the peak timing for multiple complication types in an ASD cohort at minimum 2-year follow-up. METHODS: Multicenter, prospective analysis of all complications after ASD surgery in a consecutively enrolled cohort was performed. Inclusion criteria were ASD, age ≥18 years, spinal fusion ≥4 levels, and minimum 2-year follow-up. Complications included major and minor and specific complication types. Peak timing of specific complications was identified and described. Regression analysis was performed to assess correlation between patient/surgical factors and complication timing. RESULTS: There were 280 patients who met the inclusion criteria. Mean follow-up time was 2.9 years (range, 2-5 years). Of the patients, 209 (74.6%) had at least 1 complication, accounting for 529 total complications (258 minor and 271 major). Both major and minor complications peaked at <3 months. Infection and neurologic complications peaked at <3 months. Proximal junctional kyphosis had bimodal peaks at <3 and >24 months. Implant failure peaked at 12-24 and >24 months. There was a significant positive correlation between preoperative sagittal vertical axis and total complications at 6-12 months, major complications at 24 months, and reoperation. Body mass index was associated with total complications and implant failure at 12-24 and >24 months. CONCLUSIONS: The peak timing of specific complications after ASD surgery is identifiable. Understanding when these complications are likely to occur may improve patient counseling, early diagnosis, and prophylactic interventions and may help inform future reimbursement models.
Authors: Justin S Smith; Christopher I Shaffrey; Michael P Kelly; Elizabeth L Yanik; Jon D Lurie; Christine R Baldus; Charles Edwards; Steven D Glassman; Lawrence G Lenke; Oheneba Boachie-Adjei; Jacob M Buchowski; Leah Y Carreon; Charles H Crawford; Thomas J Errico; Stephen J Lewis; Tyler Koski; Stefan Parent; Han Jo Kim; Christopher P Ames; Shay Bess; Frank J Schwab; Keith H Bridwell Journal: Spine (Phila Pa 1976) Date: 2019-09-01 Impact factor: 3.241
Authors: Samantha R Horn; Katherine E Pierce; Cheongeun Oh; Frank A Segreto; Max Egers; Cole Bortz; Dennis Vasquez-Montes; Renaud Lafage; Virginie Lafage; Shaleen Vira; Leah Steinmetz; David H Ge; John A Buza; John Moon; Bassel G Diebo; Haddy Alas; Avery E Brown; Nicholas A Shepard; Hamid Hassanzadeh; Peter G Passias Journal: Global Spine J Date: 2019-02-05
Authors: Grace Xiong; Harold Fogel; Daniel Tobert; Thomas Cha; Joseph Schwab; Christopher Bono; Stuart Hershman Journal: N Am Spine Soc J Date: 2020-12-31