TY - JOUR
T1 - The Case for Operative Efficiency in Adult Spinal Deformity Surgery
T2 - Impact of Operative Time on Complications, Length of Stay, Alignment, Fusion Rates, and Patient-Reported Outcomes
AU - International Spine Study Group
AU - Daniels, Alan H.
AU - Daher, Mohammad
AU - Singh, Manjot
AU - Balmaceno-Criss, Mariah
AU - Lafage, Renaud
AU - Diebo, Bassel G.
AU - Hamilton, David K.
AU - Smith, Justin S.
AU - Eastlack, Robert K.
AU - Fessler, Richard G.
AU - Gum, Jeffrey L.
AU - Gupta, Munish C.
AU - Hostin, Richard
AU - Kebaish, Khaled M.
AU - Klineberg, Eric O.
AU - Lewis, Stephen J.
AU - Line, Breton G.
AU - Nunley, Pierce D.
AU - Mundis, Gregory M.
AU - Passias, Peter G.
AU - Protopsaltis, Themistocles S.
AU - Buell, Thomas
AU - Scheer, Justin K.
AU - Mullin, Jeffrey P.
AU - Soroceanu, Alex
AU - Ames, Christopher P.
AU - Lenke, Lawrence G.
AU - Bess, Shay
AU - Shaffrey, Christopher I.
AU - Burton, Douglas C.
AU - Lafage, Virginie
AU - Schwab, Frank J.
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Study Design. Retrospective review of prospectively collected data. Objective. To analyze the impact of operative room (OR) time in adult spinal deformity (ASD) surgery on patient outcomes. Background. It is currently unknown if OR time in ASD patients matched for deformity severity and surgical invasiveness is associated with patient outcomes. Materials and Methods. ASD patients with baseline and two-year postoperative radiographic and patient-reported outcome measures (PROM) data, undergoing a posterior-only approach for long fusion (>L1-Ilium) were included. Patients were grouped into short OR time (<40th percentile: <359 min) and long OR time (>60th percentile: >421 min). Groups were matched by age, baseline deformity severity, and surgical invasiveness. Demographics, radiographic, PROM data, fusion rate, and complications were compared between groups at baseline and two years follow-up. Results. In total, 270 patients were included for analysis: the mean OR time was 286 minutes in the short OR group versus 510 minutes in the long OR group (P<0.001). Age, gender, percent of revision cases, surgical invasiveness, pelvic incidence minus lumbar lordosis, sagittal vertical axis, and pelvic tilt were comparable between groups (P>0.05). Short OR had a slightly lower body mass index than the short OR group (P<0.001) and decompression was more prevalent in the long OR time (P=0.042). Patients in the long group had greater hospital length of stay (P=0.02); blood loss (P<0.001); proportion requiring intensive care unit (P=0.003); higher minor complication rate (P=0.001); with no significant differences for major complications or revision procedures (P>0.5). Both groups had comparable radiographic fusion rates (P=0.152) and achieved improvement in sagittal alignment measures, Oswestry disability index, and Short Form-36 (P<0.001). Conclusion. Shorter OR time for ASD correction is associated with a lower minor complication rate, a lower estimated blood loss, fewer intensive care unit admissions, and a shorter hospital length of stay without sacrificing alignment correction or PROMs. Maximizing operative efficiency by minimizing OR time in ASD surgery has the potential to benefit patients, surgeons, and hospital systems.
AB - Study Design. Retrospective review of prospectively collected data. Objective. To analyze the impact of operative room (OR) time in adult spinal deformity (ASD) surgery on patient outcomes. Background. It is currently unknown if OR time in ASD patients matched for deformity severity and surgical invasiveness is associated with patient outcomes. Materials and Methods. ASD patients with baseline and two-year postoperative radiographic and patient-reported outcome measures (PROM) data, undergoing a posterior-only approach for long fusion (>L1-Ilium) were included. Patients were grouped into short OR time (<40th percentile: <359 min) and long OR time (>60th percentile: >421 min). Groups were matched by age, baseline deformity severity, and surgical invasiveness. Demographics, radiographic, PROM data, fusion rate, and complications were compared between groups at baseline and two years follow-up. Results. In total, 270 patients were included for analysis: the mean OR time was 286 minutes in the short OR group versus 510 minutes in the long OR group (P<0.001). Age, gender, percent of revision cases, surgical invasiveness, pelvic incidence minus lumbar lordosis, sagittal vertical axis, and pelvic tilt were comparable between groups (P>0.05). Short OR had a slightly lower body mass index than the short OR group (P<0.001) and decompression was more prevalent in the long OR time (P=0.042). Patients in the long group had greater hospital length of stay (P=0.02); blood loss (P<0.001); proportion requiring intensive care unit (P=0.003); higher minor complication rate (P=0.001); with no significant differences for major complications or revision procedures (P>0.5). Both groups had comparable radiographic fusion rates (P=0.152) and achieved improvement in sagittal alignment measures, Oswestry disability index, and Short Form-36 (P<0.001). Conclusion. Shorter OR time for ASD correction is associated with a lower minor complication rate, a lower estimated blood loss, fewer intensive care unit admissions, and a shorter hospital length of stay without sacrificing alignment correction or PROMs. Maximizing operative efficiency by minimizing OR time in ASD surgery has the potential to benefit patients, surgeons, and hospital systems.
KW - adult spinal deformity
KW - alignment
KW - blood loss
KW - complications
KW - intensive care unit
KW - length of stay
KW - operative time
KW - patient-reported outcome measures
UR - http://www.scopus.com/inward/record.url?scp=85184538139&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004873
DO - 10.1097/BRS.0000000000004873
M3 - Article
C2 - 37942794
AN - SCOPUS:85184538139
SN - 0362-2436
VL - 49
SP - 313
EP - 320
JO - Spine
JF - Spine
IS - 5
ER -