TY - JOUR
T1 - Complication Rates Following Adult Spinal Deformity Surgery
T2 - Evaluation of the Category of Complication and Chronology
AU - Lafage, Renaud
AU - Bass, R. Daniel
AU - Klineberg, Eric
AU - Smith, Justin S.
AU - Bess, Shay
AU - Shaffrey, Christopher
AU - Burton, Douglas C.
AU - Kim, Han Jo
AU - Eastlack, Robert
AU - Mundis, Gregory
AU - Ames, Christopher P.
AU - Passias, Peter G.
AU - Gupta, Munish
AU - Hostin, Richard
AU - Hamilton, Kojo
AU - Schwab, Frank
AU - Lafage, Virginie
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/6/15
Y1 - 2024/6/15
N2 - Objective. Provide benchmarks for the rates of complications by type and timing. Study Design. Prospective multicenter database. Background. Complication rates following adult spinal deformity (ASD) surgery have been previously reported. However, the interplay between timing and complication type warrants further analysis. Methods. The data for this study were sourced from a prospective, multicenter ASD database. The date and type of complication were collected and classified into three severity groups (minor, major, and major leading to reoperation). Only complications occurring before the two-year visit were retained for analysis. Results. Of the 1260 patients eligible for two-year follow-up, 997 (79.1%) achieved two-year follow-up. The overall complication rate was 67.4% (N=672). 247 patients (24.8%) experienced at least one complication on the day of surgery (including intraoperatively), 359 (36.0%) between postoperative day 1 and six weeks postoperatively, 271 (27.2%) between six weeks and one-year postoperatively, and finally 162 (16.3%) between one year and two years postoperatively. Using Kaplan-Meier survival analysis, the rate of remaining complication-free was estimated at different time points for different severities and types of complications. Stratification by type of complication demonstrated that most of the medical complications occurred within the first 60 days. Surgical complications presented over two distinct timeframes. Operative complications, incision-related complications, and infections occurred early (within 60 d), while implant-related and radiographic complications occurred at a constant rate over the two-year follow-up period. Neurological complications had the highest occurrence within the first 60 days but continued to increase up to the two-year visit. Conclusion. Only one-third of ASD patients remained complication-free by two years, and 2 of 10 patients had a complication requiring a reoperation or revision. An estimation of the timing and type of complications associated with surgical treatment may prove useful for more meaningful patient counseling and aid in assessing the cost-effectiveness of treatment. Level of Evidence. 3.
AB - Objective. Provide benchmarks for the rates of complications by type and timing. Study Design. Prospective multicenter database. Background. Complication rates following adult spinal deformity (ASD) surgery have been previously reported. However, the interplay between timing and complication type warrants further analysis. Methods. The data for this study were sourced from a prospective, multicenter ASD database. The date and type of complication were collected and classified into three severity groups (minor, major, and major leading to reoperation). Only complications occurring before the two-year visit were retained for analysis. Results. Of the 1260 patients eligible for two-year follow-up, 997 (79.1%) achieved two-year follow-up. The overall complication rate was 67.4% (N=672). 247 patients (24.8%) experienced at least one complication on the day of surgery (including intraoperatively), 359 (36.0%) between postoperative day 1 and six weeks postoperatively, 271 (27.2%) between six weeks and one-year postoperatively, and finally 162 (16.3%) between one year and two years postoperatively. Using Kaplan-Meier survival analysis, the rate of remaining complication-free was estimated at different time points for different severities and types of complications. Stratification by type of complication demonstrated that most of the medical complications occurred within the first 60 days. Surgical complications presented over two distinct timeframes. Operative complications, incision-related complications, and infections occurred early (within 60 d), while implant-related and radiographic complications occurred at a constant rate over the two-year follow-up period. Neurological complications had the highest occurrence within the first 60 days but continued to increase up to the two-year visit. Conclusion. Only one-third of ASD patients remained complication-free by two years, and 2 of 10 patients had a complication requiring a reoperation or revision. An estimation of the timing and type of complications associated with surgical treatment may prove useful for more meaningful patient counseling and aid in assessing the cost-effectiveness of treatment. Level of Evidence. 3.
KW - adult spinal deformity benchmark
KW - ASD surgery
KW - complications
KW - kaplan meier analysis
KW - survival rate
UR - http://www.scopus.com/inward/record.url?scp=85195179413&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004969
DO - 10.1097/BRS.0000000000004969
M3 - Article
C2 - 38375636
AN - SCOPUS:85195179413
SN - 0362-2436
VL - 49
SP - 829
EP - 839
JO - Spine
JF - Spine
IS - 12
ER -