A Comprehensive Review of Complication Rates after Surgery for Adult Deformity: A Reference for Informed Consent

Daniel M. Sciubba, Alp Yurter, Justin S. Smith, Michael P. Kelly, Justin K. Scheer, C. Rory Goodwin, Virginie Lafage, Robert A. Hart, Shay Bess, Khaled Kebaish, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames

Research output: Contribution to journalArticlepeer-review

113 Scopus citations


Objective An up-to-date review of recent literatures and a comprehensive reference for informed consent specific to ASD complications is lacking. The goal of the present study was to determine current complication rates after ASD surgery, in order to provide a reference for informed consent as well as to determine differences between three-column and non-three-column osteotomy procedures to aid in shared decision making. Methods A review of the literature was conducted using the PubMed database. Randomized controlled trials, nonrandomized trials, cohort studies, case-control studies, and case series providing postoperative complications published in 2000 or later were included. Complication rates were recorded and calculated for perioperative (both major and minor) and long-term complication rates. Postoperative outcomes were all stratified by surgical procedure (ie, three-column osteotomy and non-three-column osteotomy). Results Ninety-three articles were ultimately eligible for analysis. The data of 11,692 patients were extracted; there were 3,646 complications, mean age at surgery was 53.3 years (range: 25-77 years), mean follow-up was 3.49 years (range: 6 weeks-9.7 years), estimated blood loss was 2,161 mL (range: 717-7,034 mL), and the overall mean complication rate was 55%. Specifically, major perioperative complications occurred at a mean rate of 18.5%, minor perioperative complications occurred at a mean rate of 15.7%, and long-term complications occurred at a mean rate of 20.5%. Furthermore, three-column osteotomy resulted in a higher overall complication rate and estimated blood loss than non-three-column osteotomy. Conclusions A review of recent literatures providing complication rates for ASD surgery was performed, providing the most up-to-date incidence of early and late complications. Providers may use such data in helping to counsel patients of the literature-supported complication rates of such procedures despite the planned benefits, thus obtaining a more thorough informed consent.

Original languageEnglish
Pages (from-to)575-594
Number of pages20
JournalSpine deformity
Issue number6
StatePublished - 2015


  • Adult spinal deformity
  • Complications
  • PSO
  • Scoliosis
  • Three-column osteotomy


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