P79. Prevalence and surgical outcomes of primary severe sagittal plane deformity (pSPD) in adult spinal deformity (ASD) surgery: comparison between Japan and the United States

Abstract Adult spinal deformity (ASD) has gained significant attention over the past decade with improvements in diagnostic tools, classification schemes, and surgical technique. The demographics of the aging population in the United States are undergoing a fundamental shift as medical care advances and life expectancy increases. The “baby boomers” represent the fastest growing demographic in the United States and by 2050, the number of individuals 65 yr and older is projected to reach 89 million, more than double its current size. Based on current prevalence estimates there are approximately 27.5 million elderly individuals with some form of spinal deformity, which will place a significant burden on our health care systems. Rates of surgery for ASD and case complexity are both increasing, with concomitant increase in the cost of deformity care. At the same time, patients are more medically complex with increasing number of comorbidities that result in increased surgical risk and complication profiles. This review aims to highlight recent trends in the epidemiology and socioeconomic patterns in surgery for ASD.

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Lower Satisfaction After Adult Spinal Deformity Surgery in Japan Than in the United States Despite Similar SRS-22 Pain and Function Scores

Spine ◽

10.1097/brs.0000000000003483 ◽

2020 ◽

Vol 45 (17) ◽

pp. E1097-E1104

Author(s):

Mitsuru Yagi ◽

Christopher P. Ames ◽

Naobumi Hosogane ◽

Justin S. Smith ◽

Christopher I. Shaffrey ◽

...

Keyword(s):

United States ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

The United States ◽

Spinal Deformity Surgery ◽

And Function

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A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan

European Spine Journal ◽

10.1007/s00586-017-5274-5 ◽

2017 ◽

Vol 27 (3) ◽

pp. 678-684 ◽

Cited By ~ 9

Author(s):

Mitsuru Yagi ◽

◽

Christopher P. Ames ◽

Malla Keefe ◽

Naobumi Hosogane ◽

...

Keyword(s):

United States ◽

Cost Effectiveness ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

The United States ◽

Spinal Deformity Surgery

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A Critical Analysis of Sagittal Plane Deformity Correction With Minimally Invasive Adult Spinal Deformity Surgery: A 2-Year Follow-Up Study

Spine Deformity ◽

10.1016/j.jspd.2017.01.010 ◽

2017 ◽

Vol 5 (4) ◽

pp. 265-271 ◽

Cited By ~ 14

Author(s):

Gregory M. Mundis ◽

Jay D. Turner ◽

Vedat Deverin ◽

Juan S. Uribe ◽

Pierce Nunley ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Critical Analysis ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Follow Up Study ◽

Spinal Deformity Surgery ◽

Plane Deformity

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Development and validation of risk stratification models for adult spinal deformity surgery

Journal of Neurosurgery Spine ◽

10.3171/2019.3.spine181452 ◽

2019 ◽

Vol 31 (4) ◽

pp. 587-599 ◽

Cited By ~ 4

Author(s):

Ferran Pellisé ◽

Miquel Serra-Burriel ◽

Justin S. Smith ◽

Sleiman Haddad ◽

Michael P. Kelly ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

The United States ◽

Adverse Outcomes ◽

High Rate ◽

Prognostic Models ◽

Time To Event ◽

European Continent ◽

Event Risk ◽

Risk Estimates

OBJECTIVEAdult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO).METHODSTwo models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASD patients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis.RESULTSThe final sample consisted of 1612 ASD patients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%–75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs.CONCLUSIONSThe creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.

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Artificial intelligence clustering of adult spinal deformity sagittal plane morphology predicts surgical characteristics, alignment, and outcomes

European Spine Journal ◽

10.1007/s00586-021-06799-z ◽

2021 ◽

Author(s):

Wesley M. Durand ◽

◽

Renaud Lafage ◽

D. Kojo Hamilton ◽

Peter G. Passias ◽

...

Keyword(s):

Artificial Intelligence ◽

Spinal Deformity ◽

Sagittal Plane ◽

Adult Spinal Deformity

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The Natural History of Progression in Adult Spinal Deformity: A Radiographic Analysis

Global Spine Journal ◽

10.1177/2192568219845659 ◽

2019 ◽

Vol 10 (3) ◽

pp. 272-279 ◽

Cited By ~ 2

Author(s):

Sayf S. A. Faraj ◽

Niek te Hennepe ◽

Miranda L. van Hooff ◽

Martin Pouw ◽

Marinus de Kleuver ◽

...

Keyword(s):

Prognostic Factors ◽

Cobb Angle ◽

Spinal Deformity ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Coronal Plane ◽

Historical Cohort ◽

Curve Magnitude ◽

Nonsurgical Patients

Study Design: Historical cohort study. Objective: To evaluate progression in the coronal and sagittal planes in nonsurgical patients with adult spinal deformity (ASD). Methods: A retrospective analysis of nonsurgical ASD patients between 2005 and 2017 was performed. Magnitude of the coronal and sagittal planes were compared on the day of presentation and at most recent follow-up. Previous reported prognostic factors for progression in the coronal plane, including the direction of scoliosis, curve magnitude, and the position of the intercrest line (passing through L4 or L5 vertebra), were studied. Results: Fifty-eight patients were included with a mean follow-up of 59.8 ± 34.5 months. Progression in the coronal plane was seen in 72% of patients. Mean Cobb angle on the day of presentation and most recent follow-up was 37.2 ± 14.6° and 40.8° ± 16.5°, respectively. No significant differences were found in curve progression in left- versus right-sided scoliosis (3.3 ± 7.1 vs 3.7 ± 5.4, P = .81), Cobb angle <30° versus ≥30° (2.6 ± 5.0 vs 4.3 ± 6.5, P = .30), or when the intercrest line passed through L4 rather than L5 vertebra (3.4 ± 5.0° vs 3.8 ± 7.1°, P = .79). No significant differences were found in the sagittal plane between presentation and most recent follow-up. Conclusions: This is the first study that describes progression in the coronal and sagittal planes in nonsurgical patients with ASD. Previous reported prognostic factors were not confirmed as truly relevant. Although progression appears to occur, large variation exists and these results may not be directly applicable to the individual patient.

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Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000495261 ◽

2018 ◽

Vol 49 (1) ◽

pp. 11-19 ◽

Cited By ~ 10

Author(s):

Timmy Lee ◽

Joyce Qian ◽

Mae Thamer ◽

Michael Allon

Keyword(s):

United States ◽

Vascular Access ◽

Surgical Outcomes ◽

Relative Rate ◽

Venous Catheter ◽

The United States ◽

Hemodialysis Patients ◽

Elderly Male ◽

Female Patients ◽

Arteriovenous Fistulas

Background: Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). Methods: Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (≥67 years; 4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter and had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use. Results: Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52–0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36–1.56), assisted AVF use (OR 1.34, 95% CI 1.17–1.54), and AVF abandonment (HR 1.28, 95% CI 1.10–1.50), but similar relative rate of AVF interventions after successful use (relative risk [RR] 1.01, 95% CI 0.94–1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73–0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78–1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01–1.33). Conclusions: While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.

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