TY - JOUR
T1 - Benchmark Values for Construct Survival and Complications by Type of ASD Surgery
AU - On behalf of The International Spine Study Group
AU - Bass, Robert Daniel
AU - Lafage, Renaud
AU - Smith, Justin S.
AU - Ames, Christopher
AU - Bess, Shay
AU - Eastlack, Robert
AU - Gupta, Munish
AU - Hostin, Richard
AU - Kebaish, Khaled
AU - Kim, Han Jo
AU - Klineberg, Eric
AU - Mundis, Gregory
AU - Okonkwo, David
AU - Shaffrey, Christopher
AU - Schwab, Frank
AU - Lafage, Virginie
AU - Burton, Douglas
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/9/15
Y1 - 2024/9/15
N2 - Objective. The aim of this study was to provide benchmarks for the rates of complications by type of surgery performed. Study Design. Prospective multicenter database. Background. We have previously examined overall construct survival and complication rates for ASD surgery. However, the relationship between type of surgery and construct survival warrants more detailed assessment. Materials and Methods. Eight surgical scenarios were defined based on the levels treated, previous fusion status [primary (P) vs. revision (R)], and three-column osteotomy use (3CO): short lumbar fusion, LT-pelvis with 5 to 12 levels treated (P, R, or 3CO), UT-pelvis with 13 levels treated (P, R, or 3CO), and thoracic to lumbar fusion without pelvic fixation, representing 92.4% of the case in the cohort. Complication rates for each type were calculated and Kaplan-Meier curves with multivariate Cox regression analysis was used to evaluate the effect of the case characteristics on construct survival rate, while controlling for patient profile. Results. A total of 1073 of 1494 patients eligible for 2-year follow-up (71.8%) were captured. Survival curves for major complications (with or without reoperation), while controlling for demographics differed significantly among surgical types (P<0.001). Fusion procedures short of the pelvis had the best survival rate, while UT-pelvis with 3CO had the worst survival rate. Longer fusions and more invasive operations were associated with lower 2-year complication-free survival, however, there were no significant associations between type of surgery and renal, cardiac, infection, wound, gastrointestinal, pulmonary, implant malposition, or neurological complications (all P>0.5). Conclusions. This study suggests that there is an inherent increased risk of complication for some types of ASD surgery independent of patient profile. The results of this paper can be used to produce a surgery-adjusted benchmark for ASD surgery with regard to complications and survival. Such a tool can have very impactful applications for surgical decision-making and more informed patient counseling. Level of Evidence. Level III.
AB - Objective. The aim of this study was to provide benchmarks for the rates of complications by type of surgery performed. Study Design. Prospective multicenter database. Background. We have previously examined overall construct survival and complication rates for ASD surgery. However, the relationship between type of surgery and construct survival warrants more detailed assessment. Materials and Methods. Eight surgical scenarios were defined based on the levels treated, previous fusion status [primary (P) vs. revision (R)], and three-column osteotomy use (3CO): short lumbar fusion, LT-pelvis with 5 to 12 levels treated (P, R, or 3CO), UT-pelvis with 13 levels treated (P, R, or 3CO), and thoracic to lumbar fusion without pelvic fixation, representing 92.4% of the case in the cohort. Complication rates for each type were calculated and Kaplan-Meier curves with multivariate Cox regression analysis was used to evaluate the effect of the case characteristics on construct survival rate, while controlling for patient profile. Results. A total of 1073 of 1494 patients eligible for 2-year follow-up (71.8%) were captured. Survival curves for major complications (with or without reoperation), while controlling for demographics differed significantly among surgical types (P<0.001). Fusion procedures short of the pelvis had the best survival rate, while UT-pelvis with 3CO had the worst survival rate. Longer fusions and more invasive operations were associated with lower 2-year complication-free survival, however, there were no significant associations between type of surgery and renal, cardiac, infection, wound, gastrointestinal, pulmonary, implant malposition, or neurological complications (all P>0.5). Conclusions. This study suggests that there is an inherent increased risk of complication for some types of ASD surgery independent of patient profile. The results of this paper can be used to produce a surgery-adjusted benchmark for ASD surgery with regard to complications and survival. Such a tool can have very impactful applications for surgical decision-making and more informed patient counseling. Level of Evidence. Level III.
KW - adult spinal deformity benchmark
KW - ASD surgery
KW - complications
KW - Cox regression analysis
KW - Kaplan-Meier analysis
UR - http://www.scopus.com/inward/record.url?scp=85202579570&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000005012
DO - 10.1097/BRS.0000000000005012
M3 - Article
C2 - 38616765
AN - SCOPUS:85202579570
SN - 0362-2436
VL - 49
SP - 1259
EP - 1268
JO - Spine
JF - Spine
IS - 18
ER -