Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population
Retrospective review of a prospectively collected multicenter database. To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients. ASD surgery is associated with high complication rates. Evolving treatment strat...
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| Veröffentlicht in: | Spine deformity 2019-05, Vol.7 (3), p.481-488 |
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| creator | Daniels, Alan H. Reid, Daniel B.C. Tran, Stacie Nguyen Hart, Robert A. Klineberg, Eric O. Bess, Shay Burton, Douglas Smith, Justin S. Shaffrey, Christopher Gupta, Munish Ames, Christopher P. Hamilton, D. Kojo LaFage, Virginie Schwab, Frank Eastlack, Robert Akbarnia, Behrooz Kim, Han Jo Kelly, Michael Passias, Peter G. Protopsaltis, Themistocles Mundis, Gregory M. |
| description | Retrospective review of a prospectively collected multicenter database.
To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients.
ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks.
Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed.
From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative ( |
| doi_str_mv | 10.1016/j.jspd.2018.09.013 |
| format | Article |
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To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients.
ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks.
Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed.
From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008–2014 patients to 62.6% in 2015–2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05).
From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients.
Level IV.]]></description><identifier>ISSN: 2212-134X</identifier><identifier>EISSN: 2212-1358</identifier><identifier>DOI: 10.1016/j.jspd.2018.09.013</identifier><identifier>PMID: 31053319</identifier><language>eng</language><publisher>Cham: Elsevier Inc</publisher><subject>Adult spinal deformity ; ASD ; Complications ; Health-related quality of life ; Humans ; Medicine & Public Health ; Middle Aged ; Orthopedic Procedures - statistics & numerical data ; Orthopedics ; Postoperative Complications - epidemiology ; Quality of Life ; Retrospective Studies ; Spinal Curvatures - surgery ; Three-column osteotomy ; Treatment Outcome</subject><ispartof>Spine deformity, 2019-05, Vol.7 (3), p.481-488</ispartof><rights>2018 Scoliosis Research Society</rights><rights>Scoliosis Research Society 2019</rights><rights>Copyright © 2018 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-52dbade3cb3bc284ed83a58d76c769874dc3bf928b8987fd2256e295fd4475f63</citedby><cites>FETCH-LOGICAL-c466t-52dbade3cb3bc284ed83a58d76c769874dc3bf928b8987fd2256e295fd4475f63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1016/j.jspd.2018.09.013$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1016/j.jspd.2018.09.013$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31053319$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Daniels, Alan H.</creatorcontrib><creatorcontrib>Reid, Daniel B.C.</creatorcontrib><creatorcontrib>Tran, Stacie Nguyen</creatorcontrib><creatorcontrib>Hart, Robert A.</creatorcontrib><creatorcontrib>Klineberg, Eric O.</creatorcontrib><creatorcontrib>Bess, Shay</creatorcontrib><creatorcontrib>Burton, Douglas</creatorcontrib><creatorcontrib>Smith, Justin S.</creatorcontrib><creatorcontrib>Shaffrey, Christopher</creatorcontrib><creatorcontrib>Gupta, Munish</creatorcontrib><creatorcontrib>Ames, Christopher P.</creatorcontrib><creatorcontrib>Hamilton, D. Kojo</creatorcontrib><creatorcontrib>LaFage, Virginie</creatorcontrib><creatorcontrib>Schwab, Frank</creatorcontrib><creatorcontrib>Eastlack, Robert</creatorcontrib><creatorcontrib>Akbarnia, Behrooz</creatorcontrib><creatorcontrib>Kim, Han Jo</creatorcontrib><creatorcontrib>Kelly, Michael</creatorcontrib><creatorcontrib>Passias, Peter G.</creatorcontrib><creatorcontrib>Protopsaltis, Themistocles</creatorcontrib><creatorcontrib>Mundis, Gregory M.</creatorcontrib><creatorcontrib>International Spine Study Group</creatorcontrib><title>Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population</title><title>Spine deformity</title><addtitle>Spine Deform</addtitle><addtitle>Spine Deform</addtitle><description><![CDATA[Retrospective review of a prospectively collected multicenter database.
To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients.
ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks.
Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed.
From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008–2014 patients to 62.6% in 2015–2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05).
From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients.
Level IV.]]></description><subject>Adult spinal deformity</subject><subject>ASD</subject><subject>Complications</subject><subject>Health-related quality of life</subject><subject>Humans</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Orthopedic Procedures - statistics & numerical data</subject><subject>Orthopedics</subject><subject>Postoperative Complications - epidemiology</subject><subject>Quality of Life</subject><subject>Retrospective Studies</subject><subject>Spinal Curvatures - surgery</subject><subject>Three-column osteotomy</subject><subject>Treatment Outcome</subject><issn>2212-134X</issn><issn>2212-1358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1q3DAUhUVpaUKaF-iiaNlFxtGP5ZGhm2GapIWUBKaB7IQsya2MbbmSFZhn6EvnOpNkGSGQdO_5DuhchD5TUlBCq_Ou6NJkC0aoLEhdEMrfoWPGKFtRLuT713t5f4ROU-oILClLKsVHdMQpEZzT-hj9v3gIfZ59GLEf8S7HP97oHm-mKQZt_p7hbRimHmqLJJ1hPVp8k2cTBpcWQo94Y3M_493kRwC_uzbEwc_7Jy8X9_gXdL1x4-wi3s3Z7vFVDHnCt2AJVXwbptw_2X9CH1rdJ3f6fJ6gu8uL39sfq-ubq5_bzfXKlFU1rwSzjbaOm4Y3hsnSWcm1kHZdmXVVy3VpDW_amslGwqu1jInKsVq0tizXoq34Cfp68IU__ssuzWrwybi-16MLOSnGWA27EgSk7CA1MaQUXaum6Acd94oStcxBdWqZg1rmoEitYA4AfXn2z83g7CvykjoI-EGQoDVCSqoLOUJ86W3bbwfKQTYPHqhkIEHjrI_OzMoG_xb-CBSZrKQ</recordid><startdate>20190501</startdate><enddate>20190501</enddate><creator>Daniels, Alan H.</creator><creator>Reid, Daniel B.C.</creator><creator>Tran, Stacie Nguyen</creator><creator>Hart, Robert A.</creator><creator>Klineberg, Eric O.</creator><creator>Bess, Shay</creator><creator>Burton, Douglas</creator><creator>Smith, Justin S.</creator><creator>Shaffrey, Christopher</creator><creator>Gupta, Munish</creator><creator>Ames, Christopher P.</creator><creator>Hamilton, D. Kojo</creator><creator>LaFage, Virginie</creator><creator>Schwab, Frank</creator><creator>Eastlack, Robert</creator><creator>Akbarnia, Behrooz</creator><creator>Kim, Han Jo</creator><creator>Kelly, Michael</creator><creator>Passias, Peter G.</creator><creator>Protopsaltis, Themistocles</creator><creator>Mundis, Gregory M.</creator><general>Elsevier Inc</general><general>Springer International Publishing</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190501</creationdate><title>Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population</title><author>Daniels, Alan H. ; Reid, Daniel B.C. ; Tran, Stacie Nguyen ; Hart, Robert A. ; Klineberg, Eric O. ; Bess, Shay ; Burton, Douglas ; Smith, Justin S. ; Shaffrey, Christopher ; Gupta, Munish ; Ames, Christopher P. ; Hamilton, D. Kojo ; LaFage, Virginie ; Schwab, Frank ; Eastlack, Robert ; Akbarnia, Behrooz ; Kim, Han Jo ; Kelly, Michael ; Passias, Peter G. ; Protopsaltis, Themistocles ; Mundis, Gregory M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-52dbade3cb3bc284ed83a58d76c769874dc3bf928b8987fd2256e295fd4475f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult spinal deformity</topic><topic>ASD</topic><topic>Complications</topic><topic>Health-related quality of life</topic><topic>Humans</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Orthopedic Procedures - statistics & numerical data</topic><topic>Orthopedics</topic><topic>Postoperative Complications - epidemiology</topic><topic>Quality of Life</topic><topic>Retrospective Studies</topic><topic>Spinal Curvatures - surgery</topic><topic>Three-column osteotomy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Daniels, Alan H.</creatorcontrib><creatorcontrib>Reid, Daniel B.C.</creatorcontrib><creatorcontrib>Tran, Stacie Nguyen</creatorcontrib><creatorcontrib>Hart, Robert A.</creatorcontrib><creatorcontrib>Klineberg, Eric O.</creatorcontrib><creatorcontrib>Bess, Shay</creatorcontrib><creatorcontrib>Burton, Douglas</creatorcontrib><creatorcontrib>Smith, Justin S.</creatorcontrib><creatorcontrib>Shaffrey, Christopher</creatorcontrib><creatorcontrib>Gupta, Munish</creatorcontrib><creatorcontrib>Ames, Christopher P.</creatorcontrib><creatorcontrib>Hamilton, D. Kojo</creatorcontrib><creatorcontrib>LaFage, Virginie</creatorcontrib><creatorcontrib>Schwab, Frank</creatorcontrib><creatorcontrib>Eastlack, Robert</creatorcontrib><creatorcontrib>Akbarnia, Behrooz</creatorcontrib><creatorcontrib>Kim, Han Jo</creatorcontrib><creatorcontrib>Kelly, Michael</creatorcontrib><creatorcontrib>Passias, Peter G.</creatorcontrib><creatorcontrib>Protopsaltis, Themistocles</creatorcontrib><creatorcontrib>Mundis, Gregory M.</creatorcontrib><creatorcontrib>International Spine Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine deformity</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Daniels, Alan H.</au><au>Reid, Daniel B.C.</au><au>Tran, Stacie Nguyen</au><au>Hart, Robert A.</au><au>Klineberg, Eric O.</au><au>Bess, Shay</au><au>Burton, Douglas</au><au>Smith, Justin S.</au><au>Shaffrey, Christopher</au><au>Gupta, Munish</au><au>Ames, Christopher P.</au><au>Hamilton, D. Kojo</au><au>LaFage, Virginie</au><au>Schwab, Frank</au><au>Eastlack, Robert</au><au>Akbarnia, Behrooz</au><au>Kim, Han Jo</au><au>Kelly, Michael</au><au>Passias, Peter G.</au><au>Protopsaltis, Themistocles</au><au>Mundis, Gregory M.</au><aucorp>International Spine Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population</atitle><jtitle>Spine deformity</jtitle><stitle>Spine Deform</stitle><addtitle>Spine Deform</addtitle><date>2019-05-01</date><risdate>2019</risdate><volume>7</volume><issue>3</issue><spage>481</spage><epage>488</epage><pages>481-488</pages><issn>2212-134X</issn><eissn>2212-1358</eissn><abstract><![CDATA[Retrospective review of a prospectively collected multicenter database.
To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients.
ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks.
Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed.
From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008–2014 patients to 62.6% in 2015–2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05).
From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients.
Level IV.]]></abstract><cop>Cham</cop><pub>Elsevier Inc</pub><pmid>31053319</pmid><doi>10.1016/j.jspd.2018.09.013</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Spine deformity, 2019-05, Vol.7 (3), p.481-488 |
| issn | 2212-134X 2212-1358 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2229229650 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Adult spinal deformity ASD Complications Health-related quality of life Humans Medicine & Public Health Middle Aged Orthopedic Procedures - statistics & numerical data Orthopedics Postoperative Complications - epidemiology Quality of Life Retrospective Studies Spinal Curvatures - surgery Three-column osteotomy Treatment Outcome |
| title | Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population |
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