Patient satisfaction after multiple revision surgeries for adult spinal deformity

The International Spine Study Group; Wesley M. Durand; Alan H. Daniels; Kevin DiSilvestro; Renaud Lafage; Bassel G. Diebo; Peter G. Passias; Han Jo Kim; Themistocles Protopsaltis; Virginie Lafage; Justin S. Smith; Christopher I. Shaffrey; Munish C. Gupta; Eric O. Klineberg; Frank Schwab; Jeffrey L. Gum; Gregory M. Mundis; Robert K. Eastlack; Khaled Kebaish; Alex Soroceanu; Richard A. Hostin; Douglas Burton; Shay Bess; Christopher P. Ames; Robert A. Hart; D. Kojo Hamilton

doi:10.3171/2022.6.SPINE2273

Patient satisfaction after multiple revision surgeries for adult spinal deformity

The International Spine Study Group, Wesley M. Durand, Alan H. Daniels, Kevin DiSilvestro, Renaud Lafage, Bassel G. Diebo, Peter G. Passias, Han Jo Kim, Themistocles Protopsaltis, Virginie Lafage, Justin S. Smith, Christopher I. Shaffrey, Munish C. Gupta, Eric O. Klineberg, Frank Schwab, Jeffrey L. Gum, Gregory M. Mundis, Robert K. Eastlack, Khaled Kebaish, Alex SoroceanuRichard A. Hostin, Douglas Burton, Shay Bess, Christopher P. Ames, Robert A. Hart, D. Kojo Hamilton

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

OBJECTIVE Revision surgery is often necessary for adult spinal deformity (ASD) patients. Satisfaction with management is an important component of health-related quality of life. The authors hypothesized that patients who underwent multiple revision surgeries following ASD correction would exhibit lower self-reported satisfaction scores. METHODS This was a retrospective cohort study of 668 patients who underwent ASD surgery and were eligible for a minimum 2-year follow-up. Visits were stratified by occurrence prior to the index surgery (period 0), after the index surgery only (period 1), after the first revision only (period 2), and after the second revision only (period 3). Patients were further stratified by prior spine surgery before their index surgery. Scoliosis Research Society-22 (SRS-22r) health-related quality-of-life satisfaction subscore and total satisfaction scores were evaluated at all periods using multiple linear regression and adjustment for age, sex, and Charlson Comorbidity Index. RESULTS In total, 46.6% of the study patients had undergone prior spine surgery before their index surgery. The overall revision rate was 21.3%. Among patients with no spine surgery prior to the index surgery, SRS-22r satisfaction scores increased from period 0 to 1 (from 2.8 to 4.3, p < 0.0001), decreased after one revision from period 1 to 2 (4.3 to 3.9, p = 0.0004), and decreased further after a second revision from period 2 to 3 (3.9 to 3.3, p = 0.0437). Among patients with spine surgery prior to the index procedure, SRS-22r satisfaction increased from period 0 to 1 (2.8 to 4.2, p < 0.0001) and decreased from period 1 to 2 (4.2 to 3.8, p = 0.0011). No differences in follow-up time from last surgery were observed (all p > 0.3). Among patients with multiple revisions, 40% experienced rod fracture, 40% proximal junctional kyphosis, and 33% pseudarthrosis. CONCLUSIONS Among patients undergoing ASD surgery, revision surgery is associated with decreased satisfaction, and multiple revisions are associated with additive detriment to satisfaction among patients initially undergoing primary surgery. These findings have direct implications for preoperative patient counseling and establishment of postoperative expectations.

Original language	English
Pages (from-to)	75-83
Number of pages	9
Journal	Journal of Neurosurgery: Spine
Volume	38
Issue number	1
DOIs	https://doi.org/10.3171/2022.6.SPINE2273
State	Published - Jan 2023

Keywords

HRQOL
adult spinal deformity
patient satisfaction
revision surgery

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10.3171/2022.6.SPINE2273

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The International Spine Study Group, Durand, W. M., Daniels, A. H., DiSilvestro, K., Lafage, R., Diebo, B. G., Passias, P. G., Kim, H. J., Protopsaltis, T., Lafage, V., Smith, J. S., Shaffrey, C. I., Gupta, M. C., Klineberg, E. O., Schwab, F., Gum, J. L., Mundis, G. M., Eastlack, R. K., Kebaish, K., ... Hamilton, D. K. (2023). Patient satisfaction after multiple revision surgeries for adult spinal deformity. Journal of Neurosurgery: Spine, 38(1), 75-83. https://doi.org/10.3171/2022.6.SPINE2273

@article{c01defc7cab44bfa957014be7bf862aa,

title = "Patient satisfaction after multiple revision surgeries for adult spinal deformity",

abstract = "OBJECTIVE Revision surgery is often necessary for adult spinal deformity (ASD) patients. Satisfaction with management is an important component of health-related quality of life. The authors hypothesized that patients who underwent multiple revision surgeries following ASD correction would exhibit lower self-reported satisfaction scores. METHODS This was a retrospective cohort study of 668 patients who underwent ASD surgery and were eligible for a minimum 2-year follow-up. Visits were stratified by occurrence prior to the index surgery (period 0), after the index surgery only (period 1), after the first revision only (period 2), and after the second revision only (period 3). Patients were further stratified by prior spine surgery before their index surgery. Scoliosis Research Society-22 (SRS-22r) health-related quality-of-life satisfaction subscore and total satisfaction scores were evaluated at all periods using multiple linear regression and adjustment for age, sex, and Charlson Comorbidity Index. RESULTS In total, 46.6% of the study patients had undergone prior spine surgery before their index surgery. The overall revision rate was 21.3%. Among patients with no spine surgery prior to the index surgery, SRS-22r satisfaction scores increased from period 0 to 1 (from 2.8 to 4.3, p < 0.0001), decreased after one revision from period 1 to 2 (4.3 to 3.9, p = 0.0004), and decreased further after a second revision from period 2 to 3 (3.9 to 3.3, p = 0.0437). Among patients with spine surgery prior to the index procedure, SRS-22r satisfaction increased from period 0 to 1 (2.8 to 4.2, p < 0.0001) and decreased from period 1 to 2 (4.2 to 3.8, p = 0.0011). No differences in follow-up time from last surgery were observed (all p > 0.3). Among patients with multiple revisions, 40% experienced rod fracture, 40% proximal junctional kyphosis, and 33% pseudarthrosis. CONCLUSIONS Among patients undergoing ASD surgery, revision surgery is associated with decreased satisfaction, and multiple revisions are associated with additive detriment to satisfaction among patients initially undergoing primary surgery. These findings have direct implications for preoperative patient counseling and establishment of postoperative expectations.",

keywords = "HRQOL, adult spinal deformity, patient satisfaction, revision surgery",

author = "{The International Spine Study Group} and Durand, {Wesley M.} and Daniels, {Alan H.} and Kevin DiSilvestro and Renaud Lafage and Diebo, {Bassel G.} and Passias, {Peter G.} and Kim, {Han Jo} and Themistocles Protopsaltis and Virginie Lafage and Smith, {Justin S.} and Shaffrey, {Christopher I.} and Gupta, {Munish C.} and Klineberg, {Eric O.} and Frank Schwab and Gum, {Jeffrey L.} and Mundis, {Gregory M.} and Eastlack, {Robert K.} and Khaled Kebaish and Alex Soroceanu and Hostin, {Richard A.} and Douglas Burton and Shay Bess and Ames, {Christopher P.} and Hart, {Robert A.} and Hamilton, {D. Kojo}",

note = "Funding Information: sultant for Alphatec and Globus Medical; receiving royalties from NuVasive; having ownership in VFT Solutions LLC; and being a committee member of SRS and ISSG. Dr. Smith reports being a consultant for Zimmer Biomet, Carlsmed, DePuy Synthes, NuVasive, Stryker, SeaSpine, and Cerapedics; receiving royalties from Zimmer Biomet, NuVasive, and Thieme; having direct stock ownership in Alphatec and NuVasive; receiving clinical or research support for the study described (includes equipment or material) from DePuy Synthes/ISSGF; and receiving support of non–study-related clinical or research effort overseen by the author from DePuy Synthes/ISSGF, NuVasive, and AO Spine. Dr. Shaffrey reports being a consultant for NuVasive, Medtronic, SI Bone, and Proprio; having direct stock ownership in NuVasive; being a patent holder in NuVasive, Medtronic, and Zimmer Biomet; and receiving royalties from NuVasive, Medtronic, Zimmer Biomet, and SI Bone. Dr. Gupta reports being a consultant for DePuy, Globus, and Medtronic; receiving royalties from Innomed, DePuy, and Globus; having direct stock ownership in J&J; receiving honoraria from AO Spine, Wright State, LSU, and the Malaysia Spine Society; and receiving other benefits from the Scoliosis Research Society Board of Directors, travel for course faculty; DePuy travel; Medtronic travel; Zimmer travel; AO Spine travel; and the National Health Spine Foundation Scientific Advisory Board, voluntary/nonfinancial. Dr. Klineberg reports being a consultant for DePuy Synthes, Stryker, and Medicrea/Medtronic; serving on the speakers bureau for AO Spine; and receiving a fellowship grant from AONA. Dr. Schwab reports direct stock ownership in VFT Solutions and SeaSpine; being a consultant for Zimmer Biomet, Medtronic, and Mainstay Medical; receiving royalties from Zimmer Biomet, Medtronic, and Medicrea; receiving support of non–study-related clinical or research effort overseen by the author from DePuy, K2M, NuVasive, Medtronic, Globus, AlloSource, Orthofix, and SI Bone—paid through ISSGF; and being an executive committee member of the International Spine Study Group (ISSG). Dr. Gum reports direct stock ownership in Cingulate Therapeutics, Inc.; being an employee for Norton Healthcare; being a consultant for Acuity, DePuy, Medtronic, NuVasive, and Stryker; being a patent holder in Medtronic; receiving honoraria from Baxter, Broadwater, NASS, and Pacira Pharmaceuticals; being on the speakers bureau for Medtronic and Stryker; receiving clinical or research support for the study described (includes equipment or material) from the Alan L. & Jacqueline B. Stuart Spine Center, Cerapedics, Inc., Biom{\textquoteright}Up, Medtronic, Pfizer, Scoliosis Research Society, Texas Scottish Rites Hospital, Empirical Spine, National Spine Health Foundation, and Stryker; receiving royalties from Acuity, Medtronic, and NuVasive; serving on the medical/scientific board for the National Spine Health Foundation; and serving as a reviewer for Global Spine Journal, Spine Deformity, and Spine Journal. Dr. Mundis reports being a consultant for NuVasive, Carlsmed, SeaSpine, and Viseon; being a patent holder in Stryker; and receiving royalties from NuVasive and K2M/Stryker. Dr. Eastlack reports being a consultant for NuVasive, SI Bone, SeaSpine, Spinal Elements, Biedermann Motech, Carevature, Medtronic, and DePuy; having direct stock ownership in NuVasive, SeaSpine, SI Bone, and Alphatec; being a patent holder in Spine Innovation, Globus, NuVasive, SI Bone, and SeaSpine; receiving support of non–study-related clinical or research effort overseen by the author from NuVasive, SeaSpine, SI Bone, Medtronic, and AONA; serving on the speakers bureau for Radius; and receiving royalties from NuVasive, SeaSpine, SI Bone, and Globus. Dr. Burton reports ownership of Progenerative Medical; being a consultant for and receiving royalties from Globus; receiving royalties from Blue Ocean Spine; and receiving clinical or research support for the study described (includes equipment or material) from DePuy and ISSGF. Dr. Bess reports being a consultant for Mirus, Stryker, and ATEC; being a patent holder in K2M/Stryker and NuVasive; receiving clinical or research support for the study described (includes equipment or material) from DePuy Synthes, NuVasive, ISSGF, and Stryker; receiving support of non–study-related clinical or research effort overseen by the author from DePuy Synthes, NuVasive, Stryker, Medtronic, Globus, SI Bone, SeaSpine, Carlsmed, and ISSGF; and serving on the speakers bureau for Stryker and ATEC. Dr. Ames reports receiving royalties from Stryker, Biomet Zimmer Spine, DePuy Synthes, NuVasive, Next Orthosurgical, K2M, Medicrea, and DePuy Synthes; being a consultant for Medtronic, Medicrea, K2M, Agada Medical, and Carlsmed; performing research for Titan Spine, DePuy Synthes, and ISSG; serving on the editorial board for Operative Neurosurgery; receiving grant funding from SRS; serving on the executive committee of ISSG; serving as director of Global Spinal Analytics; and being chair of the SRS Safety and Value Committee. Dr. Hart reports being a consultant for AlloSource, Globus, Orthofix, MiRus, DePuy, Medtronic, PropioVision, and SeaSpine. Funding Information: This study was supported by the International Spine Study Group Foundation (ISSGF). Dr. Daniels reports being a consultant for Spineart, Stryker, Medtronic, Medicrea, EOS, and Orthofix. Dr. Passias reports being a consultant for Medtronic, Globus, and Royal Biologics. Dr. Protopsaltis reports being a consultant for Globus, NuVasive, K2M/Stryker, and Medtronic; receiving royalties from Altus; being a stock option unit holder in Spine Align; holding stock options in Torus; and receiving support of non–study-related clinical or research effort overseen by the author from Medtronic. Dr. Lafage reports receiving honoraria Publisher Copyright: {\textcopyright} 2023 American Association of Neurological Surgeons. All rights reserved.",

year = "2023",

month = jan,

doi = "10.3171/2022.6.SPINE2273",

language = "English",

volume = "38",

pages = "75--83",

journal = "Journal of Neurosurgery: Spine",

issn = "1547-5654",

number = "1",

}

The International Spine Study Group, Durand, WM, Daniels, AH, DiSilvestro, K, Lafage, R, Diebo, BG, Passias, PG, Kim, HJ, Protopsaltis, T, Lafage, V, Smith, JS, Shaffrey, CI, Gupta, MC, Klineberg, EO, Schwab, F, Gum, JL, Mundis, GM, Eastlack, RK, Kebaish, K, Soroceanu, A, Hostin, RA, Burton, D, Bess, S, Ames, CP, Hart, RA & Hamilton, DK 2023, 'Patient satisfaction after multiple revision surgeries for adult spinal deformity', Journal of Neurosurgery: Spine, vol. 38, no. 1, pp. 75-83. https://doi.org/10.3171/2022.6.SPINE2273

TY - JOUR

T1 - Patient satisfaction after multiple revision surgeries for adult spinal deformity

AU - The International Spine Study Group

AU - Durand, Wesley M.

AU - Daniels, Alan H.

AU - DiSilvestro, Kevin

AU - Lafage, Renaud

AU - Diebo, Bassel G.

AU - Passias, Peter G.

AU - Kim, Han Jo

AU - Protopsaltis, Themistocles

AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Shaffrey, Christopher I.

AU - Gupta, Munish C.

AU - Klineberg, Eric O.

AU - Schwab, Frank

AU - Gum, Jeffrey L.

AU - Mundis, Gregory M.

AU - Eastlack, Robert K.

AU - Kebaish, Khaled

AU - Soroceanu, Alex

AU - Hostin, Richard A.

AU - Burton, Douglas

AU - Bess, Shay

AU - Ames, Christopher P.

AU - Hart, Robert A.

AU - Hamilton, D. Kojo

N1 - Funding Information: sultant for Alphatec and Globus Medical; receiving royalties from NuVasive; having ownership in VFT Solutions LLC; and being a committee member of SRS and ISSG. Dr. Smith reports being a consultant for Zimmer Biomet, Carlsmed, DePuy Synthes, NuVasive, Stryker, SeaSpine, and Cerapedics; receiving royalties from Zimmer Biomet, NuVasive, and Thieme; having direct stock ownership in Alphatec and NuVasive; receiving clinical or research support for the study described (includes equipment or material) from DePuy Synthes/ISSGF; and receiving support of non–study-related clinical or research effort overseen by the author from DePuy Synthes/ISSGF, NuVasive, and AO Spine. Dr. Shaffrey reports being a consultant for NuVasive, Medtronic, SI Bone, and Proprio; having direct stock ownership in NuVasive; being a patent holder in NuVasive, Medtronic, and Zimmer Biomet; and receiving royalties from NuVasive, Medtronic, Zimmer Biomet, and SI Bone. Dr. Gupta reports being a consultant for DePuy, Globus, and Medtronic; receiving royalties from Innomed, DePuy, and Globus; having direct stock ownership in J&J; receiving honoraria from AO Spine, Wright State, LSU, and the Malaysia Spine Society; and receiving other benefits from the Scoliosis Research Society Board of Directors, travel for course faculty; DePuy travel; Medtronic travel; Zimmer travel; AO Spine travel; and the National Health Spine Foundation Scientific Advisory Board, voluntary/nonfinancial. Dr. Klineberg reports being a consultant for DePuy Synthes, Stryker, and Medicrea/Medtronic; serving on the speakers bureau for AO Spine; and receiving a fellowship grant from AONA. Dr. Schwab reports direct stock ownership in VFT Solutions and SeaSpine; being a consultant for Zimmer Biomet, Medtronic, and Mainstay Medical; receiving royalties from Zimmer Biomet, Medtronic, and Medicrea; receiving support of non–study-related clinical or research effort overseen by the author from DePuy, K2M, NuVasive, Medtronic, Globus, AlloSource, Orthofix, and SI Bone—paid through ISSGF; and being an executive committee member of the International Spine Study Group (ISSG). Dr. Gum reports direct stock ownership in Cingulate Therapeutics, Inc.; being an employee for Norton Healthcare; being a consultant for Acuity, DePuy, Medtronic, NuVasive, and Stryker; being a patent holder in Medtronic; receiving honoraria from Baxter, Broadwater, NASS, and Pacira Pharmaceuticals; being on the speakers bureau for Medtronic and Stryker; receiving clinical or research support for the study described (includes equipment or material) from the Alan L. & Jacqueline B. Stuart Spine Center, Cerapedics, Inc., Biom’Up, Medtronic, Pfizer, Scoliosis Research Society, Texas Scottish Rites Hospital, Empirical Spine, National Spine Health Foundation, and Stryker; receiving royalties from Acuity, Medtronic, and NuVasive; serving on the medical/scientific board for the National Spine Health Foundation; and serving as a reviewer for Global Spine Journal, Spine Deformity, and Spine Journal. Dr. Mundis reports being a consultant for NuVasive, Carlsmed, SeaSpine, and Viseon; being a patent holder in Stryker; and receiving royalties from NuVasive and K2M/Stryker. Dr. Eastlack reports being a consultant for NuVasive, SI Bone, SeaSpine, Spinal Elements, Biedermann Motech, Carevature, Medtronic, and DePuy; having direct stock ownership in NuVasive, SeaSpine, SI Bone, and Alphatec; being a patent holder in Spine Innovation, Globus, NuVasive, SI Bone, and SeaSpine; receiving support of non–study-related clinical or research effort overseen by the author from NuVasive, SeaSpine, SI Bone, Medtronic, and AONA; serving on the speakers bureau for Radius; and receiving royalties from NuVasive, SeaSpine, SI Bone, and Globus. Dr. Burton reports ownership of Progenerative Medical; being a consultant for and receiving royalties from Globus; receiving royalties from Blue Ocean Spine; and receiving clinical or research support for the study described (includes equipment or material) from DePuy and ISSGF. Dr. Bess reports being a consultant for Mirus, Stryker, and ATEC; being a patent holder in K2M/Stryker and NuVasive; receiving clinical or research support for the study described (includes equipment or material) from DePuy Synthes, NuVasive, ISSGF, and Stryker; receiving support of non–study-related clinical or research effort overseen by the author from DePuy Synthes, NuVasive, Stryker, Medtronic, Globus, SI Bone, SeaSpine, Carlsmed, and ISSGF; and serving on the speakers bureau for Stryker and ATEC. Dr. Ames reports receiving royalties from Stryker, Biomet Zimmer Spine, DePuy Synthes, NuVasive, Next Orthosurgical, K2M, Medicrea, and DePuy Synthes; being a consultant for Medtronic, Medicrea, K2M, Agada Medical, and Carlsmed; performing research for Titan Spine, DePuy Synthes, and ISSG; serving on the editorial board for Operative Neurosurgery; receiving grant funding from SRS; serving on the executive committee of ISSG; serving as director of Global Spinal Analytics; and being chair of the SRS Safety and Value Committee. Dr. Hart reports being a consultant for AlloSource, Globus, Orthofix, MiRus, DePuy, Medtronic, PropioVision, and SeaSpine. Funding Information: This study was supported by the International Spine Study Group Foundation (ISSGF). Dr. Daniels reports being a consultant for Spineart, Stryker, Medtronic, Medicrea, EOS, and Orthofix. Dr. Passias reports being a consultant for Medtronic, Globus, and Royal Biologics. Dr. Protopsaltis reports being a consultant for Globus, NuVasive, K2M/Stryker, and Medtronic; receiving royalties from Altus; being a stock option unit holder in Spine Align; holding stock options in Torus; and receiving support of non–study-related clinical or research effort overseen by the author from Medtronic. Dr. Lafage reports receiving honoraria Publisher Copyright: © 2023 American Association of Neurological Surgeons. All rights reserved.

PY - 2023/1

Y1 - 2023/1

N2 - OBJECTIVE Revision surgery is often necessary for adult spinal deformity (ASD) patients. Satisfaction with management is an important component of health-related quality of life. The authors hypothesized that patients who underwent multiple revision surgeries following ASD correction would exhibit lower self-reported satisfaction scores. METHODS This was a retrospective cohort study of 668 patients who underwent ASD surgery and were eligible for a minimum 2-year follow-up. Visits were stratified by occurrence prior to the index surgery (period 0), after the index surgery only (period 1), after the first revision only (period 2), and after the second revision only (period 3). Patients were further stratified by prior spine surgery before their index surgery. Scoliosis Research Society-22 (SRS-22r) health-related quality-of-life satisfaction subscore and total satisfaction scores were evaluated at all periods using multiple linear regression and adjustment for age, sex, and Charlson Comorbidity Index. RESULTS In total, 46.6% of the study patients had undergone prior spine surgery before their index surgery. The overall revision rate was 21.3%. Among patients with no spine surgery prior to the index surgery, SRS-22r satisfaction scores increased from period 0 to 1 (from 2.8 to 4.3, p < 0.0001), decreased after one revision from period 1 to 2 (4.3 to 3.9, p = 0.0004), and decreased further after a second revision from period 2 to 3 (3.9 to 3.3, p = 0.0437). Among patients with spine surgery prior to the index procedure, SRS-22r satisfaction increased from period 0 to 1 (2.8 to 4.2, p < 0.0001) and decreased from period 1 to 2 (4.2 to 3.8, p = 0.0011). No differences in follow-up time from last surgery were observed (all p > 0.3). Among patients with multiple revisions, 40% experienced rod fracture, 40% proximal junctional kyphosis, and 33% pseudarthrosis. CONCLUSIONS Among patients undergoing ASD surgery, revision surgery is associated with decreased satisfaction, and multiple revisions are associated with additive detriment to satisfaction among patients initially undergoing primary surgery. These findings have direct implications for preoperative patient counseling and establishment of postoperative expectations.

AB - OBJECTIVE Revision surgery is often necessary for adult spinal deformity (ASD) patients. Satisfaction with management is an important component of health-related quality of life. The authors hypothesized that patients who underwent multiple revision surgeries following ASD correction would exhibit lower self-reported satisfaction scores. METHODS This was a retrospective cohort study of 668 patients who underwent ASD surgery and were eligible for a minimum 2-year follow-up. Visits were stratified by occurrence prior to the index surgery (period 0), after the index surgery only (period 1), after the first revision only (period 2), and after the second revision only (period 3). Patients were further stratified by prior spine surgery before their index surgery. Scoliosis Research Society-22 (SRS-22r) health-related quality-of-life satisfaction subscore and total satisfaction scores were evaluated at all periods using multiple linear regression and adjustment for age, sex, and Charlson Comorbidity Index. RESULTS In total, 46.6% of the study patients had undergone prior spine surgery before their index surgery. The overall revision rate was 21.3%. Among patients with no spine surgery prior to the index surgery, SRS-22r satisfaction scores increased from period 0 to 1 (from 2.8 to 4.3, p < 0.0001), decreased after one revision from period 1 to 2 (4.3 to 3.9, p = 0.0004), and decreased further after a second revision from period 2 to 3 (3.9 to 3.3, p = 0.0437). Among patients with spine surgery prior to the index procedure, SRS-22r satisfaction increased from period 0 to 1 (2.8 to 4.2, p < 0.0001) and decreased from period 1 to 2 (4.2 to 3.8, p = 0.0011). No differences in follow-up time from last surgery were observed (all p > 0.3). Among patients with multiple revisions, 40% experienced rod fracture, 40% proximal junctional kyphosis, and 33% pseudarthrosis. CONCLUSIONS Among patients undergoing ASD surgery, revision surgery is associated with decreased satisfaction, and multiple revisions are associated with additive detriment to satisfaction among patients initially undergoing primary surgery. These findings have direct implications for preoperative patient counseling and establishment of postoperative expectations.

KW - HRQOL

KW - adult spinal deformity

KW - patient satisfaction

KW - revision surgery

UR - http://www.scopus.com/inward/record.url?scp=85145425697&partnerID=8YFLogxK

U2 - 10.3171/2022.6.SPINE2273

DO - 10.3171/2022.6.SPINE2273

M3 - Article

C2 - 36029263

AN - SCOPUS:85145425697

SN - 1547-5654

VL - 38

SP - 75

EP - 83

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

IS - 1

ER -

Patient satisfaction after multiple revision surgeries for adult spinal deformity

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