scholarly journals Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

2015 ◽  
Vol 23 (5) ◽  
pp. 656-664 ◽  
Author(s):  
Alex Soroceanu ◽  
Douglas C. Burton ◽  
Bassel Georges Diebo ◽  
Justin S. Smith ◽  
Richard Hostin ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Obese Patients ◽  
Estimated Blood Loss ◽  
Sf 36 ◽  
Patient Reported ◽  
The Impact

OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement overtime, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.

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

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.

Predictors of Revision Surgery in Adult Spinal Deformity and Impact on Patient-Reported Outcomes and Satisfaction: Two-Year Follow-Up

2014 ◽  
Vol 14 (11) ◽  
pp. S21 ◽  
Author(s):  
Peter G. Passias ◽  
Sun Yang ◽  
Alexandra Soroceanu ◽  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Patient Reported

Complications and Patient-Reported Outcomes of Primary versus Revision Surgery for Severe Adult Spinal Deformity: A ScoliRisk-1 Sub-Analysis

2016 ◽  
Vol 16 (10) ◽  
pp. S326-S327
Author(s):  
Amit Jain ◽  
Floreana Naef ◽  
Lawrence G. Lenke ◽  
Christopher I. Shaffrey ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Patient Reported

The Impact of Radiculopathy on Patient-Reported Outcomes: A Propensity Matched Study on 386 Adult Spinal Deformity Patients with and without Leg Pain

2016 ◽  
Vol 16 (10) ◽  
pp. S193-S194
Author(s):  
Renaud Lafage ◽  
Justin K. Scheer ◽  
Barthelemy Liabaud ◽  
Frank J. Schwab ◽  
Justin S. Smith ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Leg Pain ◽  
Patient Reported ◽  
Matched Study ◽  
The Impact

Postoperative Coronal Malalignment is Associated with Significantly Poor Patient Reported Outcomes in Operatively Treated Adult Spinal Deformity

2015 ◽  
Vol 15 (10) ◽  
pp. S148-S149 ◽  
Author(s):  
International Spine Study Group ◽  
Amit Jain ◽  
Christopher P. Ames ◽  
Brian J. Neuman ◽  
Daniel M. Sciubba ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Poor Patient ◽  
Patient Reported ◽  
Coronal Malalignment

scholarly journals Body Mass Index Greater Than 35 Is Associated With Increased Major and Radiographic Complications After Minimally Invasive Adult Spinal Deformity Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Khoi D Than ◽  
Stacie Tran ◽  
Dean Chou ◽  
Kai-Ming G Fu ◽  
Paul Park ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Surgical Site Infections ◽  
Neurological Complications ◽  
Obese Patients ◽  
The Impact

Abstract INTRODUCTION As the obesity epidemic continues and the recognition of adult spinal deformity (ASD) increases, a growing number of obese patients are undergoing surgery to correct ASD. Minimally invasive techniques may be advantageous for obese patients to minimize blood loss. To date, the literature examining the impact of obesity on complications after minimally invasive ASD surgery has been scarce. METHODS A multicenter database of ASD patients was reviewed. Patients who had at least 2 yr of follow-up were analyzed. Demographic, radiographic, clinical outcomes, and postoperative complications were assessed. A body mass index (BMI) threshold of 35 was selected to more accurately reflect real-world practices. RESULTS A total of 220 patients were included: 196 had a BMI <35 and 24 had a BMI >35 (26.3 vs 38.4, P < .001). When comparing patients with a BMI threshold of 35, there was no difference in baseline age, levels instrumented, and most pre- and postoperative radiographic parameters and clinical outcomes. Patients with BMI >35 did have higher preopearative back pain than BMI <35 (visual analog scale 7.9 vs 6.8, P = .013) and postoperative Cobb angle (17.8 vs 12.6, P = .031). There was no difference between groups in overall complications, reoperations, infections, implant failures, surgical site infections, or minor, cardiopulmonary, gastrointestinal, and operative complications. Patients with BMI >35 had more major (45.8% vs 23.0%, P = .015) and radiographic (37.5% vs 19.9%, P = .049) complications than patients with BMI <35. Patients with BMI <35 had more neurological complications (17.3% vs 0%, P = .026). CONCLUSION In this retrospective review of a large database of patients undergoing minimally invasive surgery for ASD, patients with BMI > 35 suffered from more major and radiographic complications but fewer neurological complications than patients with BMI <35.

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

68. Early patient-reported outcomes can be used to identify patients at risk for poor 1-year outcomes in adult spinal deformity

2019 ◽  
Vol 19 (9) ◽  
pp. S34
Author(s):  
Alvaro Ibaseta ◽  
Rafa Rahman ◽  
Nicholas S. Andrade ◽  
Richard L. Skolasky ◽  
Lee H. Riley ◽  
...  
Keyword(s):  
At Risk ◽  
Spinal Deformity ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Patient Reported ◽  
Patients At Risk

scholarly journals Long-term clinical and radiographic outcomes and patient satisfaction after adult spinal deformity correction

2018 ◽  
Vol 108 (4) ◽  
pp. 343-351 ◽  
Author(s):  
K. Kyrölä ◽  
H. Kautiainen ◽  
L. Pekkanen ◽  
P. Mäkelä ◽  
I. Kiviranta ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Spinal Deformity ◽  
Oswestry Disability Index ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Research Society ◽  
Scoliosis Research Society ◽  
Patient Reported ◽  
Poor Outcomes

Background and Aims: Adult spinal deformity surgery has increased with the aging population and modern surgical approaches, although it has high complication and reoperation rates. The permanence of radiographic correction, mechanical complications, predictive factors for poor patient-reported outcomes, and patient satisfaction were analyzed. Material and Methods: A total of 79 adult patients were retrospectively analyzed at baseline and 1–9 years after adult spinal deformity correction between 2007 and 2016. Patient-reported outcomes (Oswestry Disability Index, visual analog scale, and Scoliosis Research Society–30 scores), changes in radiographic alignment, indications for reoperation, predictors of poor outcomes according to the Oswestry Disability Index and Scoliosis Research Society–30 scores, and patient satisfaction with management were studied. Results: Oswestry Disability Index and visual analog scale scores (p = 0.001), radiographic correction of thoracic kyphosis, lumbar lordosis, and pelvic retroversion (p ⩽ 0.001) and sagittal vertical axis (p = 0.043) were significantly better at 4–5 years of follow-up than at baseline. The risk for the first reoperation owing to mechanical failure of instrumentation or bone was highest within the first year, at 13.9% (95% confidence interval = 8.0%–23.7%), and 29.8% (95% confidence interval = 19.4%–43.9%) at the 5-year follow-up. Oswestry Disability Index and Scoliosis Research Society–30 total scores had a good correlation (r = −0.78; 95% CI = −0.86 to –0.68; p < 0.001). Satisfaction with management was correlated with patient-reported outcomes. Male sex and depression (p = 0.021 and 0.018, respectively) predicted poor outcomes according to the Oswestry Disability Index and/or Scoliosis Research Society–30 score. Conclusion: The achieved significant radiographic correction was maintained 5 years postoperatively. Despite reoperations, patient satisfaction and clinical outcomes were good. Depression and male sex predicted poor clinical outcomes.

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