Introduction: Surgery for ASD is associated with high complications, some requiring secondary surgery (SS). Complications resulting in SS may be due to unalterable patient risk factors. Purpose: Compare profiles and 2-year outcomes for ASD patients undergoing SS vs. patients that did not have SS (NOSS), and identify high risk complications associated with SS.
Methods: Multi-center, prospective analysis of consecutive ASD patients (age=18 years and scoliosis =20°, sagittal vertical axis =5cm, pelvic tilt =25°, or thoracic kyphosis >60°). Inclusion criteria: spinal fusion =4 levels for ASD, complete data, minimum two-year follow-up. Patients divided into SS and NOSS. Risk factors for SS, complications, and timing of SS evaluated. Baseline and 2-year postop HRQOL (SRS-22r, SF-36, ODI) analyzed.
Results: 141 of 189 patients (75%) met criteria. Mean follow up=35.8 months (range=24.1-47.9). Two year SS incidence was 21% (n=29). SS had similar mean age, BMI, smoking status, ASA grade, Charlson comorbidity index, deformity, deformity correction, EBL, OR time, posterior fusion levels and length of hospital stay as NOSS (n=112; p>0.05). Of 18 complications, wound infection (relative risk=8.7), implant failure (relative risk=4.2) and proximal junctional kyphosis (PJK; relative risk=2.6) were associated with SS vs. NOSS (p<0.05). Timing of SS following index surgery was greatest at <3 months (37.4%) and 12-24 months (37.4%; p<0.05). Two year HRQOL values were similar SS vs. NOSS, including improvement in ODI (13.3 vs. 15.3), SRS-22r total (0.7 vs. 0.9), SF-36 PCS (5.8 vs. 9.1) and final SRS-22r satisfaction scores (4.1 vs. 4.3), respectively (p>0.05).
Conclusions: Comparison of SS vs. NOSS in consecutive ASD patients demonstrated no single patient variable predictive for SS. Wound infection, implant failure and PJK are high risk complications for SS. SS did not have a detrimental impact on 2-year HRQOL or satisfaction vs. NOSS. Future research should evaluate high risk complications for SS and prevention techniques.
Patient Care: Improve our understanding of surgical treatment strategies for adults with spinal deformity.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Understand that surgery for adult spinal deformity is associated with high complication rates, with some requiring additional surgery; (2) Appreciate that wound infection, implant failure and PJK are high risk complications for needing additional surgery