Prospective Multicenter Assessment of Intraoperative and Perioperative Complication Rates Associated with Adult Spinal Deformity (ASD) Surgery in 558 Patients

Background: Adult spinal deformity (ASD) are typically managed in tertiary care centres due to their complexity in surgical planning and peri-operative care. Methods: A retrospective analysis of consecutive corrective ASD surgery performed by a single surgeon at a community based centre performed between 2012 and 2014. Inclusion criteria were age ≥ 18 years with a minimum of 1 year follow-up. We reviewed age, aetiology, mortality, medical and neurological deficit. All standard radiographic deformity parameters were also evaluated and analysed. Results: n=32 corrective spinal deformity procedures were performed. The most common aetiology was de novo degenerative scoliosis. The mean length of stay was 11.94 days. The most common levels fused from T1-pelvis (n=13). L5/S1 was the most common level requiring interbody fusion (n=17). There were n=10 who required a PSO. Only n=4 patients had EBL greater than 3500cc.There were a total of 9 medical complications with post-operative hypotension being the most common (n=3). Hardware failure across the PSO site was the most common long term complication (n=7). There were n=2 death. There were no reported deep infections requiring revisions. Radiographic parameters analysed showed significant improvement. Conclusions: ASD surgery perioperative complication rates in a community hospital are similar to those done in high volume academic centre.

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Rod-Screw Constructs Composed of Dissimilar Metals Do Not Affect Complication Rates in Posterior Fusion Surgery Performed for Adult Spinal Deformity

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001058 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sahitya K. Denduluri ◽

Jayme C.B. Koltsov ◽

Chason Ziino ◽

Nicole Segovia ◽

Craig McMains ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Posterior Fusion ◽

Dissimilar Metals ◽

Complication Rates ◽

Fusion Surgery

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Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Journal of Neurosurgery Spine ◽

10.3171/2015.11.spine151036 ◽

2016 ◽

Vol 25 (1) ◽

pp. 1-14 ◽

Cited By ~ 130

Author(s):

Justin S. Smith ◽

Eric Klineberg ◽

Virginie Lafage ◽

Christopher I. Shaffrey ◽

Frank Schwab ◽

...

Keyword(s):

Patient Care ◽

Spinal Deformity ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Vena Cava ◽

Complication Rates ◽

Inclusion Criteria ◽

Patient Counseling ◽

Delayed Complications

OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.

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ASA Classification as a Risk Stratification Tool in Adult Spinal Deformity Surgery: A Study of 5805 Patients

Global Spine Journal ◽

10.1177/2192568217700106 ◽

2017 ◽

Vol 7 (8) ◽

pp. 719-726 ◽

Cited By ~ 15

Author(s):

Sulaiman Somani ◽

John Di Capua ◽

Jun S. Kim ◽

Kevin Phan ◽

Nathan J. Lee ◽

...

Keyword(s):

Logistic Regression ◽

Risk Stratification ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Wound Complications ◽

Complication Rates ◽

Multivariate Logistic Regression ◽

Improvement Program ◽

Asa Classification ◽

Increased Risk

Study Design: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery. Methods: The 2010-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision, codes relevant to ASD surgery. Patients were divided based on their ASA classification. Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications for patients with increased ASA scores. Results: A total of 5805 patients met the inclusion criteria, 2718 (46.8%) of which were ASA class I-II and 3087 (53.2%) were ASA class III-IV. Multivariate logistic regression revealed ASA class to be a significant risk factor for mortality (odds ratio [OR] = 21.0), reoperation within 30 days (OR = 1.6), length of stay ≥5 days (OR = 1.7), overall morbidity (OR = 1.4), wound complications (OR = 1.8), pulmonary complications (OR = 2.3), cardiac complications (OR = 3.7), intra-/postoperative red blood cell transfusion (OR = 1.3), postoperative sepsis (OR = 2.7), and urinary tract infection (OR = 1.6). Conclusions: This is the first study evaluating the role of ASA class in ASD surgery with a large patient database. Use of ASA class as a metric for preoperative health was verified and the association of ASA class with postoperative morbidity and mortality in ASD surgery suggests its utility in refining the risk stratification profile and improving preoperative patient counseling for those individuals undergoing ASD surgery.

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Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes

Global Spine Journal ◽

10.1177/2192568220937473 ◽

2020 ◽

Vol 10 (7) ◽

pp. 896-907

Author(s):

Eric O. Klineberg ◽

Peter G. Passias ◽

Gregory W. Poorman ◽

Cyrus M. Jalai ◽

Abiola Atanda ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Spinal Deformity ◽

Surgical Outcomes ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Complication Rates ◽

Estimated Blood Loss ◽

Patient Reported ◽

The Impact

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

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Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity

Spine ◽

10.1097/brs.0000000000002929 ◽

2019 ◽

Vol 44 (10) ◽

pp. 723-731 ◽

Cited By ~ 4

Author(s):

Mitsuru Yagi ◽

Takehiro Michikawa ◽

Naobumi Hosogane ◽

Nobuyuki Fujita ◽

Eijiro Okada ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Complication Rates ◽

Corrective Surgery

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Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

Neurosurgical FOCUS ◽

10.3171/2017.9.focus17475 ◽

2017 ◽

Vol 43 (6) ◽

pp. E9 ◽

Cited By ~ 4

Author(s):

David B. Bumpass ◽

Lawrence G. Lenke ◽

Jeffrey L. Gum ◽

Christopher I. Shaffrey ◽

Justin S. Smith ◽

...

Keyword(s):

Sex Differences ◽

Spinal Deformity ◽

Operative Time ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Spine Deformity ◽

Complication Rates ◽

Female Patients ◽

Male Patients

OBJECTIVEAdolescent spine deformity studies have shown that male patients require longer surgery and have greater estimated blood loss (EBL) and complications compared with female patients. No studies exist to support this relationship in adult spinal deformity (ASD). The purpose of this study was to investigate associations between sex and complications, deformity correction, and health-related quality of life (HRQOL) in patients with ASD. It was hypothesized that male ASD patients would have greater EBL, longer surgery, and more complications than female ASD patients.METHODSA multicenter ASD cohort was retrospectively queried for patients who underwent primary posterior-only instrumented fusions with a minimum of 5 levels fused. The minimum follow-up was 2 years. Primary outcomes were EBL, operative time, intra-, peri-, and postoperative complications, radiographic correction, and HRQOL outcomes (Oswestry Disability Index, SF-36, and Scoliosis Research Society-22r Questionnaire). Poisson multivariate regression was used to control for age, comorbidities, and levels fused.RESULTSNinety male and 319 female patients met the inclusion criteria. Male patients had significantly greater mean EBL (2373 ml vs 1829 ml, p = 0.01). The mean operative time, transfusion requirements, and final radiographic measurements did not differ between sexes. Similarly, changes in HRQOL showed no significant differences. Finally, there were no sex differences in the incidence of complications (total, major, or minor) at any time point after controlling for age, body mass index, comorbidities, and levels fused.CONCLUSIONSDespite higher EBL, male ASD patients did not experience more complications or require less deformity correction at the 2-year follow-up. HRQOL scores similarly showed no sex differences. These findings differ from adolescent deformity studies, and surgeons can counsel patients that sex is unlikely to influence the outcomes and complication rates of primary all-posterior ASD surgery.

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Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis

Journal of Neurosurgery Spine ◽

10.3171/2015.4.spine141329 ◽

2016 ◽

Vol 24 (1) ◽

pp. 124-130 ◽

Cited By ~ 13

Author(s):

Michael P. Kelly ◽

Lukas P. Zebala ◽

Han Jo Kim ◽

Daniel M. Sciubba ◽

Justin S. Smith ◽

...

Keyword(s):

Spinal Deformity ◽

Blood Donation ◽

Adult Spinal Deformity ◽

Autologous Blood ◽

Cohort Analysis ◽

Blood Transfusions ◽

Complication Rates ◽

Autologous Blood Donation ◽

Eligibility Criteria ◽

Preoperative Autologous Blood Donation

OBJECT The goal of this study was to examine the effectiveness of preoperative autologous blood donation (PABD) in adult spinal deformity (ASD) surgery. METHODS Patients undergoing single-stay ASD reconstructions were identified in a multicenter database. Patients were divided into groups according to PABD (either PABD or NoPABD). Propensity weighting was used to create matched cohorts of PABD and NoPABD patients. Allogeneic (ALLO) exposure, autologous (AUTO) wastage (unused AUTO), and complication rates were compared between groups. RESULTS Four hundred twenty-eight patients were identified as meeting eligibility criteria. Sixty patients were treated with PABD, of whom 50 were matched to 50 patients who were not treated with PABD (NoPABD). Nearly one-third of patients in the PABD group (18/60, 30%) did not receive any autologous transfusion and donated blood was wasted. In 6 of these cases (6/60, 10%), patients received ALLO blood transfusions without AUTO. In 9 cases (9/60, 15%), patients received ALLO and AUTO blood transfusions. Overall rates of transfusion of any type were similar between groups (PABD 70% [42/60], NoPABD 75% [275/368], p = 0.438). Major and minor in-hospital complications were similar between groups (Major PABD 10% [6/60], NoPABD 12% [43/368], p = 0.537; Minor PABD 30% [18/60], NoPABD 24% [87/368], p = 0.499). When controlling for potential confounders, PABD patients were more likely to receive some transfusion (OR 15.1, 95% CI 2.1-106.7). No relationship between PABD and ALLO blood exposure was observed, however, refuting the concept that PABD is protective against ALLO blood exposure. In the matched cohorts, PABD patients were more likely to sustain a major perioperative cardiac complication (PABD 8/50 [16%], NoPABD 1/50 [2%], p = 0.046). No differences in rates of infection or wound-healing complications were observed between cohorts. CONCLUSIONS Preoperative autologous blood donation was associated with a higher probability of perioperative transfusions of any type in patients with ASD. No protective effect of PABD against ALLO blood exposure was observed, and no risk of perioperative infectious complications was observed in patients exposed to ALLO blood only. The benefit of PABD in patients with ASD remains undefined.

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Complication Rates Associated with 3-Column Osteotomy in 82 Adult Spinal Deformity Patients: Retrospective Review of a Prospectively Collected Multicenter Consecutive Series with Minimum Two-Year Follow-Up

The Spine Journal ◽

10.1016/j.spinee.2016.07.313 ◽

2016 ◽

Vol 16 (10) ◽

pp. S376-S377 ◽

Cited By ~ 2

Author(s):

Justin S. Smith ◽

Munish C. Gupta ◽

Eric O. Klineberg ◽

Christopher I. Shaffrey ◽

Frank J. Schwab ◽

...

Keyword(s):

Spinal Deformity ◽

Retrospective Review ◽

Adult Spinal Deformity ◽

Consecutive Series ◽

Complication Rates

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State-of-the-art reviews predictive modeling in adult spinal deformity: applications of advanced analytics

Spine Deformity ◽

10.1007/s43390-021-00360-0 ◽

2021 ◽

Author(s):

Rushikesh S. Joshi ◽

Darryl Lau ◽

Justin K. Scheer ◽

Miquel Serra-Burriel ◽

Alba Vila-Casademunt ◽

...

Keyword(s):

Machine Learning ◽

Spinal Deformity ◽

Clinical Decision Making ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Machine Learning Algorithms ◽

Surgical Correction ◽

Computational Techniques ◽

Dramatic Improvement ◽

Complication Rates

AbstractAdult spinal deformity (ASD) is a complex and heterogeneous disease that can severely impact patients’ lives. While it is clear that surgical correction can achieve significant improvement of spinopelvic parameters and quality of life measures in adults with spinal deformity, there remains a high risk of complication associated with surgical approaches to adult deformity. Over the past decade, utilization of surgical correction for ASD has increased dramatically as deformity correction techniques have become more refined and widely adopted. Along with this increase in surgical utilization, there has been a massive undertaking by spine surgeons to develop more robust models to predict postoperative outcomes in an effort to mitigate the relatively high complication rates. A large part of this revolution within spine surgery has been the gradual adoption of predictive analytics harnessing artificial intelligence through the use of machine learning algorithms. The development of predictive models to accurately prognosticate patient outcomes following ASD surgery represents a dramatic improvement over prior statistical models which are better suited for finding associations between variables than for their predictive utility. Machine learning models, which offer the ability to make more accurate and reproducible predictions, provide surgeons with a wide array of practical applications from augmenting clinical decision making to more wide-spread public health implications. The inclusion of these advanced computational techniques in spine practices will be paramount for improving the care of patients, by empowering both patients and surgeons to more specifically tailor clinical decisions to address individual health profiles and needs.

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