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Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis

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Abstract

Study Design

Longitudinal cohort.

Objectives

To identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity.

Summary of Background Data

Increasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient’s health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity.

Methods

The data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events.

Results

Of 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071).

Conclusions

Factors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient’s quality of life.

Level of Evidence

Level II. Prospective cohort.

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Author information

Authors and Affiliations

  1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Leah Y. Carreon MD, MSc & Steven D. Glassman MD

  2. Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA, 22908, USA

    Christopher I. Shaffrey MD

  3. Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. Suite 4WW-449, Toronto, ON, M5T2S8, Canada

    Michael G. Fehlings MD, PhD

  4. Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, København Ø, Denmark

    Benny Dahl MD

  5. Department of Neurological Surgery, University of California, San Francisco, California, 400 Parnassus Ave, San Francisco, CA, 94143, USA

    Christopher P. Ames MD

  6. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan

    Yukihiro Matsuyama MD, PhD

  7. Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China

    Yong Qiu MD, PhD

  8. Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Derby Rd, Nottingham, NG7 2UH, UK

    Hossein Mehdian MD

  9. Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China

    Kenneth M. C. Cheung MD

  10. Hospital for Special Surgery, 523 East 72nd Street, New York, NY, 10021, USA

    Frank J. Schwab MD

  11. Spine Surgery Unit, Hospital Vall d’Hebron, Traumatology Building 2nd Floor, Passeig Vall Hebron 119-129, Barcelona, 08035, Spain

    Ferran Pellisé MD, PhD

  12. Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA

    Khaled M. Kebaish MD

  13. The Spine Hospital, Columbia University Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA

    Lawrence G. Lenke MD

Authors
  1. Leah Y. Carreon MD, MSc
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  2. Steven D. Glassman MD
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  3. Christopher I. Shaffrey MD
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  4. Michael G. Fehlings MD, PhD
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  5. Benny Dahl MD
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  6. Christopher P. Ames MD
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  7. Yukihiro Matsuyama MD, PhD
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  8. Yong Qiu MD, PhD
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  9. Hossein Mehdian MD
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  10. Kenneth M. C. Cheung MD
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  11. Frank J. Schwab MD
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  12. Ferran Pellisé MD, PhD
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  13. Khaled M. Kebaish MD
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  14. Lawrence G. Lenke MD
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Additional information

Author disclosures

LYC (none); SDG (grants from Scoliosis Research Society, AO Spine, and Norton Healthcare, during the conduct of the study; other from Medtronic, Norton Healthcare, and NuVasive, outside the submitted work; and past president, Scoliosis Research Society); CIS (none); MGF (none); BD (none); CPA (grants from Scoliosis Research Society, AO Spine, and Norton Healthcare, during the conduct of the study; personal fees from Stryker, Medtronic, DePuy, and Biomet Spine, outside the submitted work; and a patent, Fish & Richardson, P.C. issued); YM (none); YQ (none); HM (none); KMCC (none); FJS (grants from Scoliosis Research Society, AO Spine, and Norton Healthcare, during the conduct of the study; grants from DePuy Spine Synthesis; personal fees from MSD, Medicrea, K2M, ZimmerBiomet, and NuVasive, other from Nemaris INC, outside the submitted work); FP (none); KMK (none); LGL (none).

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Carreon, L.Y., Glassman, S.D., Shaffrey, C.I. et al. Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis. Spine Deform 5, 139–144 (2017). https://doi.org/10.1016/j.jspd.2016.11.001

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  • DOI: https://doi.org/10.1016/j.jspd.2016.11.001

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