TY - JOUR
T1 - Critical Analysis of Radiographic and Patient-Reported Outcomes Following Anterior/Posterior Staged Versus Same-Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity
AU - Passias, Peter G.
AU - Ahmad, Waleed
AU - Tretiakov, Peter S.
AU - Lafage, Renaud
AU - Lafage, Virginie
AU - Schoenfeld, Andrew J.
AU - Line, Breton
AU - Daniels, Alan
AU - Mir, Jamshaid M.
AU - Gupta, Munish
AU - Mundis, Gregory
AU - Eastlack, Robert
AU - Nunley, Pierce
AU - Hamilton, D. Kojo
AU - Hostin, Richard
AU - Hart, Robert
AU - Burton, Douglas C.
AU - Shaffrey, Christopher
AU - Schwab, Frank
AU - Ames, Christopher
AU - Smith, Justin S.
AU - Bess, Shay
AU - Klineberg, Eric O.
N1 - Publisher Copyright:
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - Study Design. A retrospective cohort study of a prospectively collected multicenter adult spinal deformity (ASD) database. Objective. The aim of this study was to compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for the treatment of ASD. Background. Surgical intervention for ASD is an invasive and complex procedure that surgeons often elect to perform on different days (staging). Yet, there remains a paucity of literature on the timing and effects of the interval between stages. Materials and Methods. ASD patients with 2-year data undergoing an anterior/posterior (A/P) fusion to the ilium were included. Propensity score matching was performed for the number of levels fused, number of interbody devices, surgical approaches, number of osteotomies/three-column osteotomy, frailty, Oswestry Disability Index, Charlson Comorbidity Index, revisions, sagittal vertical axis, pelvic incidence-lumbar lordosis, and upper instrumented vertebrae to create balanced cohorts of same-day and staged surgical patients. Staged patients were stratified by intervening time-period between surgeries, using quartiles. Results. A total of 176 propensity score-matched patients were included. The median interval between A/P staged procedures was 3 days. Staged patients had greater operative time and lower intensive care unit stays postoperatively (P<0.05). At 2 years, staged compared with same-day showed a greater improvement in T1 slope-cervical lordosis, C2 sacral slope, and SRS-Schwab sagittal vertical axis (P<0.05). Staged patients had higher rates of minimal clinically important difference for 1-year SRS-Appearance and 2-year Physical Component Summary scores. Assessing different intervals of staging, patients at the 75th percentile interval showed greater improvement in 1-year SRS-Pain and SRS-Total postoperative as well as SRS-Activity, Pain, Satisfaction, and Total scores (P<0.05) compared with patients in lower quartiles. Compared with the 25th percentile, patients reaching the 50th percentile interval were associated with increased odds of improvement in Global Alignment and Proportion score proportionality [9.3 (1.6-53.2), P=0.01]. Conclusions. This investigation is among the first to compare multicenter staged and same-day surgery A/P ASD patients fused to ilium using propensity matching. Staged procedures resulted in significant improvement radiographically, reduced intensive care unit admissions, and superior patient-reported outcomes compared with same-day procedures. An interval of at least 3 days between staged procedures is associated with superior outcomes in terms of Global Alignment and Proportion score proportionality.
AB - Study Design. A retrospective cohort study of a prospectively collected multicenter adult spinal deformity (ASD) database. Objective. The aim of this study was to compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for the treatment of ASD. Background. Surgical intervention for ASD is an invasive and complex procedure that surgeons often elect to perform on different days (staging). Yet, there remains a paucity of literature on the timing and effects of the interval between stages. Materials and Methods. ASD patients with 2-year data undergoing an anterior/posterior (A/P) fusion to the ilium were included. Propensity score matching was performed for the number of levels fused, number of interbody devices, surgical approaches, number of osteotomies/three-column osteotomy, frailty, Oswestry Disability Index, Charlson Comorbidity Index, revisions, sagittal vertical axis, pelvic incidence-lumbar lordosis, and upper instrumented vertebrae to create balanced cohorts of same-day and staged surgical patients. Staged patients were stratified by intervening time-period between surgeries, using quartiles. Results. A total of 176 propensity score-matched patients were included. The median interval between A/P staged procedures was 3 days. Staged patients had greater operative time and lower intensive care unit stays postoperatively (P<0.05). At 2 years, staged compared with same-day showed a greater improvement in T1 slope-cervical lordosis, C2 sacral slope, and SRS-Schwab sagittal vertical axis (P<0.05). Staged patients had higher rates of minimal clinically important difference for 1-year SRS-Appearance and 2-year Physical Component Summary scores. Assessing different intervals of staging, patients at the 75th percentile interval showed greater improvement in 1-year SRS-Pain and SRS-Total postoperative as well as SRS-Activity, Pain, Satisfaction, and Total scores (P<0.05) compared with patients in lower quartiles. Compared with the 25th percentile, patients reaching the 50th percentile interval were associated with increased odds of improvement in Global Alignment and Proportion score proportionality [9.3 (1.6-53.2), P=0.01]. Conclusions. This investigation is among the first to compare multicenter staged and same-day surgery A/P ASD patients fused to ilium using propensity matching. Staged procedures resulted in significant improvement radiographically, reduced intensive care unit admissions, and superior patient-reported outcomes compared with same-day procedures. An interval of at least 3 days between staged procedures is associated with superior outcomes in terms of Global Alignment and Proportion score proportionality.
KW - adult spinal deformity
KW - anterior-posterior fusion
KW - same-day
KW - stage
UR - http://www.scopus.com/inward/record.url?scp=85192756327&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004774
DO - 10.1097/BRS.0000000000004774
M3 - Article
C2 - 37450674
AN - SCOPUS:85192756327
SN - 0362-2436
VL - 49
SP - 893
EP - 901
JO - Spine
JF - Spine
IS - 13
ER -