Impact of resolved early major complications on 2-year follow-up outcome following adult spinal deformity surgery
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.
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.
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).
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.
KeywordsAdult spinal deformity Complications Outcome
Depuy Synthes Spine research Grant funds were received in support of this study. The results of this study were presented at the XXXII GEER Meeting (Spanish Spine Society).
Complinace with ethical standards
Conflict of interest
SNP and AVC have no conflict of interest. AA, EA, FP, IO, FK and FJSPG have received grants from Depuy Synthes Spine), AA and FP have received grants from Medtronic. FP, IO and FJSPG are consultants for Depuy Synthes Spine, FP is consultant for K2M and IO is Consultant for Medtronic. IO receives royalties from Alpahtech, Clariance and Spineart).
- 3.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 CrossRefGoogle Scholar
- 4.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 CrossRefGoogle Scholar
- 6.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 CrossRefGoogle Scholar
- 9.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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar