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01-09-2019 | Original Article

Impact of resolved early major complications on 2-year follow-up outcome following adult spinal deformity surgery

Authors: Susana Núñez-Pereira, Ferran Pellisé, Alba Vila-Casademunt, Ahmet Alanay, Emre Acaraglou, Ibrahim Obeid, Francisco Javier Sánchez Pérez-Grueso, Frank Kleinstück, ESSG European Spine Study Group

Published in: European Spine Journal | Issue 9/2019

Abstract

Purpose

Major complications are a concern following ASD surgery. Even when properly managed and resolved, they may still have a relevant impact on HRQL. We aimed to investigate the impact of resolved early major complications on 2-year outcome after ASD surgery.

Methods

Two groups of consecutive surgical patients were extracted from a prospective multicentre database. Major complication group (MCG) included patients with any major complication, resolved within 6 months after surgery. Patients with further major complications during follow-up were excluded. Control group (CG) included patients with no major complications over the entire follow-up. Analysis of covariance adjusting for preoperative baseline values was used to compare improvements in HRQL measures at 2 years.

Results

One hundred and seventy-five patients met the inclusion criteria and had complete HRQL data at 2 years (24 MCG, 151 CG). MCG patients were older and had more severe deformity and poorer baseline HRQL. There were 27 resolved major complications at 6 months needing 19 additional surgeries (18 revisions, 1 cholecystectomy). At 2 years, and after adjusting for preoperative data, outcome in MCG patients was as follows: scores were 5.98 (SE 3.03) points higher for the ODI (p = 0.05), 0.36 (SE 0.13) lower SRS-22 function (p = 0.01), 4.07 (SE 1.93) lower SF-36 PCS (p = 0.04), and 0.16 (SE 0.13) lower SRS-22 subtotal (p = 0.22).

Conclusion

The results indicate that patients experiencing major complications after ASD surgery have significantly less functional improvement (SRS-22 function, ODI, SF-36 PCS) than their complication-free counterparts, even when complications were considered resolved, and the outcome was measured after an 18-month complication-free period.

Graphical abstract

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Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW, Perra JH, Boachie-Adjei O, Shaffrey CI (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36(9):E593–E597. https://doi.org/10.1097/BRS.0b013e3182059bfd CrossRef

Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D, Study Group on Scoliosis (2012) Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976) 37(8):693–700. https://doi.org/10.1097/BRS.0b013e31822ff5c1 CrossRef

Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GR Jr et al (2016) Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25(1):1–14. https://doi.org/10.3171/2015.11.SPINE151036 CrossRefPubMed

Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S et al (2015) A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 3(6):575–594. https://doi.org/10.1016/j.jspd.2015.04.005 CrossRefPubMed

Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH (2007) Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 32(20):2238–2244. https://doi.org/10.1097/BRS.0b013e31814cf24a CrossRef

Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D, Crawford CH 3rd, O’Shaughnessy BA, Buchowski JM et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 37(14):1198–1210. https://doi.org/10.1097/BRS.0b013e31824fffde CrossRef

Christiansen PA, LaBagnara M, Sure DR, Shaffrey CI, Smith JS (2016) Complications of surgical intervention in adult lumbar scoliosis. Curr Rev Musculoskelet Med 9(3):281–289. https://doi.org/10.1007/s12178-016-9357-4 CrossRefPubMedPubMedCentral

Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine (Phila Pa 1976) 32(24):2764–2770. https://doi.org/10.1097/BRS.0b013e31815a7644 CrossRef

Scheer JK, Mundis GM, Klineberg E, Hart RA, Deviren V, Burton DC, Protopsaltis TS, Gupta M et al (2016) Recovery following adult spinal deformity surgery: the effect of complications and reoperation in 149 patients with 2-year follow-up. Eur Spine J 25(8):2612–2621. https://doi.org/10.1007/s00586-015-3787-3 CrossRefPubMed

10.

Obeid I, Boissière L, Yilgor C, Larrieu D, Pellisé F, Alanay A, Acaroglu E, Pérez-Grueso F et al (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25(11):3644–3649. https://doi.org/10.1007/s00586-016-4649-3 CrossRefPubMed

11.

Mannion AF, Fekete TF, O'Riordan D, Porchet F, Mutter UM, Jeszenszky D, Lattig F, Grob D, Kleinstueck FS (2013) The assessment of complications after spine surgery: time for a paradigm shift? Spine J 13(6):615–624. https://doi.org/10.1016/j.spinee.2013.01.047 CrossRefPubMed

12.

Hart RA, Cabalo A, Bess S, Akbarnia BA, Boachie-Adjei O, Burton D, Cunningham ME, Gupta M, Hostin R (2013) Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery. Spine (Phila Pa 1976) 38(9):732–736. https://doi.org/10.1097/BRS.0b013e31827ae242 CrossRef

13.

Lambat MP, Glassman SD, Carreon LY (2013) Impact of perioperative complications on clinical outcome scores in lumbar fusion surgery. J Neurosurg Spine 18(3):265–268. https://doi.org/10.3171/2012.12.SPINE12805 CrossRefPubMed

14.

Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA et al (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976) 36(10):817–824. https://doi.org/10.1097/BRS.0b013e3181e21783 CrossRef

15.

Cho SK, Bridwell KH, Lenke LG, Cho W, Zebala LP, Pahys JM, Kang MM, Yi SJ, Baldus CR (2011) Comparative analysis of clinical outcome and complications in primary vs. revision adult scoliosis surgery. Spine (Phila Pa 1976) 37(5):393–401. https://doi.org/10.1097/BRS.0b013e31821f0126 CrossRef

16.

Fu L, Chang MS, Crandall DG, Revella J (2014) Comparative analysis of clinical outcomes and complications in patients with degenerative scoliosis undergoing primary versus revision surgery. Spine (Phila Pa 1976) 39(10):805–811. https://doi.org/10.1097/BRS.0000000000000283 CrossRef

17.

Scheer JK, Mundis GM, Klineberg E, Hart RA, Deviren V, Nguyen S, Protopsaltis PS, Gupta M, Bess S et al (2015) Postoperative recovery after adult spinal deformity surgery: comparative analysis of age in 149 patients during 2-year follow-up. Spine (Phila Pa 1976) 40(19):1505–1515. https://doi.org/10.1097/BRS.0000000000001062 CrossRef

18.

Soroceanu A, Burton DC, Oren JH, Smith JS, Hostin R, Shaffrey CI, Akbarnia BA, Ames CP, Errico TJ et al (2016) Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine (Phila Pa 1976) 41(22):1718–1723. https://doi.org/10.1097/BRS.0000000000001636 CrossRef

19.

Gvozdyev BV, Carreon LY, Graves CM, Riley SA, McGraw KE, Head RJ, Dimar JR 2nd, Glassman SD (2017) Patient-reported outcome scores underestimate the impact of major complications in patients undergoing spine surgery for degenerative conditions. J Neurosurg Spine 27(4):397–402CrossRefPubMed

20.

Glassman SD, Bridwell KH, Shaffrey CI, Edwards CC 2nd, Lurie JD, Baldus CR et al (2018) Health-related quality of life scores underestimate the impact of major complications in lumbar degenerative scoliosis surgery. Spine Deform 6(1):67–71CrossRefPubMedPubMedCentral

21.

Soroceanu A, Diebo BG, Burton D, Smith JS, Deviren V, Shaffrey C, Kim HJ, Mundis G, Ames C et al (2015) Radiographical and implant-related complications in adult spinal deformity surgery: incidence, patient risk factors, and impact on health-related quality of life. Spine (Phila Pa 1976) 40(18):1414–1421. https://doi.org/10.1097/BRS.0000000000001020 CrossRef

22.

Miller EK, Vila-Casademunt A, Neuman BJ, Sciubba DM, Kebaish KM, Smith JS, Alanay A, Acaroglu ER et al (2018) External validation of the adult spinal deformity (ASD) frailty index (ASD-FI). Eur Spine J 27(9):2331–2338. https://doi.org/10.1007/s00586-018-5575-3 CrossRefPubMed

23.

Núñez-Pereira S, Vila-Casademunt A, Domingo-Sàbat M, Bagó J, Acaroglu ER, Alanay A, Obeid I, Sánchez Pérez-Grueso FJ, Kleinstück F, Pellisé F (2018) Impact of early unanticipated revision surgery on health-related quality of life after adult spinal deformity surgery. Spine J 18(6):926–934. https://doi.org/10.1016/j.spinee.2017.09.017 CrossRefPubMed

24.

Scheer JK, Tang JA, Smith JS, Klineberg E, Hart RA, Mundis GM, Burton DC, Hostin R, O’Brien MF et al (2013) Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database: Clinical article. J Neurosurg Spine 19(4):464–470. https://doi.org/10.3171/2013.7.SPINE12901 CrossRefPubMed

25.

Kasparek MF, Boettner F, Rienmueller A, Weber M, Funovics PT, Krepler P, Windhager R, Grohs J (2018) Predicting medical complications in spine surgery: evaluation of a novel online risk calculator. Eur Spine J 27(10):2449–2456. https://doi.org/10.1007/s00586-018-5707-9 CrossRefPubMed

26.

Lee MJ, Cizik AM, Hamilton D, Chapman JR (2014) Predicting medical complications after spine surgery: a validated model using a prospective surgical registry. Spine J 14(2):291–299. https://doi.org/10.1016/j.spinee.2013.10.043 CrossRefPubMed

27.

Veeravagu A, Li A, Swinney C, Tian L, Moraff A, Azad TD, Cheng I, Alamin T, Hu SS et al (2017) Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool. J Neurosurg Spine 27(1):81–91. https://doi.org/10.3171/2016.12.SPINE16969 CrossRefPubMed

Title: Impact of resolved early major complications on 2-year follow-up outcome following adult spinal deformity surgery
Authors: Susana Núñez-Pereira
Ferran Pellisé
Alba Vila-Casademunt
Ahmet Alanay
Emre Acaraglou
Ibrahim Obeid
Francisco Javier Sánchez Pérez-Grueso
Frank Kleinstück
ESSG European Spine Study Group
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 9/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06041-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of resolved early major complications on 2-year follow-up outcome following adult spinal deformity surgery

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

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