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  • Reoperation Rates and Impact on Outcome in a Large Prospective Multicenter Adult Spinal Deformity Database

    Final Number:
    371

    Authors:
    Christopher P. Ames MD; Justin K. Scheer PhD; Justin S. Smith MD PhD; Eric Klineberg MD; Robert Hart MD; Gregory Mundis MD; Douglas C. Burton MD; Richard A. Hostin MD; Michael F. OBrien MD; Christopher I. Shaffrey MD, FACS; Shay Bess MD; Frank Schwab MD; Khaled Kebaish MD; Vedat Deviren MD; International Spine Study Group

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Adult spinal deformity is historically associated with relatively high rates of complications and need for reoperation. Reoperation within 30 days and 1 year may be important quality metrics that will require baseline rates at centers of excellence to set acceptable occurrence standards of these events. Analysis of the rates, timeframe and reasons for reoperation, and impact on clinical outcomes may identify potential areas for care improvement.

    Methods: The rates of reoperation within 30 days and 1 year were assessed based on a large multicenter adult deformity database of 316 operative patients, 205 of which had minimum 1 year follow-up. Reasons for reoperation and its impact on the Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS) outcomes measures at 1year were assessed. Smoking history, Charlson, and ASA scores were also assessed.

    Results: 45/316 patients(14%) had required reoperation at any time(11>1yr). 34(17%) required reoperation within 1yr of initial surgery, including 13(6%) within 30 days following initial surgery. Reoperation indications included: instrumentation malposition/fracture(n=16), proximal junction failure(n=9), neurological compromise(n=6), pseudarthrosis(n=4), coronal imbalance(n=3), infection(n=3), distal junction failure(n=2), adjacent segment degeneration(n=1), and hematoma(n=1). Patients requiring reoperation were significantly older than those not requiring reoperation within the first year of surgery(62.6 vs 57.4 years, p=0.03). Compared with patients not requiring reoperation, those needing reoperation had worse outcomes measure at 1 year follow-up, including ODI(36 vs 23, p=0.017) and SRS total score and all subscores(p<0.05)(Table). There were no significant differences between reop and nonreop pts for Charlson, ASA, or smoking hx.

    Conclusions: The results show age may have an effect on the reoperation rate and that reoperation within 1yr does have an effect on health-related quality of life at 1 year. The most common indications for reoperation (instrumentation complications and radiographic failure) reinforce the importance of preoperative planning, intraoperative imaging and surgical technique.

    Patient Care: This research improves patient care by providing reoperation rates and the impact on outcome for adults with spinal deformity. These data may prove useful for surgical planning and for patient counseling.

    Learning Objectives: By the conclusion of this presentation, participants should: 1) appreciate that older patients may be more likely to have a reoperation within 1 year, 2) identify major complications requiring reoperation within 1 year from a large adult spinal deformity patient population, and 3) understand that reoperation in 1yr may adversely affect HRQOL at 1 year.

    References:

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