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Do readmissions and reoperations adversely affect patient-reported outcomes following complex adult spinal deformity surgery at a minimum 2 years postoperative?

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Abstract

Background

Unplanned readmissions and reoperations are known to be associated with undesirable costs and potentially inferior outcomes in complex adult spinal deformity (ASD) surgery. A paucity of literature exists on the impact of readmissions/reoperations on patient-reported outcomes (PRO) in this population.

Methods

Consecutively treated adult patients who underwent complex ASD surgery at a single institution from 2015–2018 and minimum 2-year follow-up were studied. Demographics/comorbidities, operative factors, inpatient complications, and postoperative clinical and patient-reported outcomes (SRS-22r, ODI) were assessed for those with and without readmission/reoperation.

Results

175 patients (72% female, mean age 52.6 ± 16.4) were included. Mean total instrumented/fused levels was 13.3 ± 4.1, range 6–25. The readmission and reoperation rates were 16.6% and 12%, respectively. The two most common causes of reoperation were pseudarthrosis (5.1%) and PJK (4.0%). Predictors for readmission within 2 years following surgery included pulmonary, cardiac, depression and gastrointestinal comorbidities, along with performance of a VCR, and TLIF. At 2 years postoperatively, those who required a readmission/reoperation had significant increases in SRS and reductions in ODI compared to 1-year and preoperative values. Inpatient complications did not negatively impact 2-year PRO’s. The 2-year MCID in PROs was not significantly different between those with and without readmission/reoperation.

Conclusion

Complex ASD surgery carries risk, but the vast majority can achieve MCID (SRS-86.4%, ODI-68.2%) in PROs by 2 years. Importantly, even those with inpatient complications and those who required unplanned readmission/reoperation can improve PROs by 2-year follow-up compared to preoperative baseline and 1-year follow-up and achieve similar improvements compared to those who did not require a readmission.

Level of evidence

III.

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Funding

There was no financial support for this research project.

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Authors and Affiliations

  1. Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, 161 Fort Washington Avenue, New York, NY, 10032, USA

    Nathan J. Lee, Meghan Cerpa, Eric Leung, Zeeshan M. Sardar, Ronald A. Lehman & Lawrence G. Lenke

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  1. Nathan J. Lee
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  2. Meghan Cerpa
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Contributions

NL and MC: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, final approval of the version to be published, contributed effort to the study; EL and ZS: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work, revising the work critically for important intellectual content, final approval of the version to be published, contributed effort to the study; RAL and LGL: substantial contributions to the conception and design of the work, revising the work critically for important intellectual content, final approval of the version to be published, contributed cases or effort to the study.

Corresponding author

Correspondence to Meghan Cerpa.

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Conflict of interest

LGL reports being a consultant for Medtronic (money donated to charity); receiving royalties from Medtronic and Quality Medical Publishing; receiving reimbursement for airfare and hotels from Broadwater, the Seattle Science Foundation, Stryker Spine, the Spinal Research Foundation, AOSpine, and the Scoliosis Research Society; receiving grant support from the Scoliosis Research Society (money to his institution), EOS Imaging (money to his institution), the Setting Scoliosis Straight Foundation (money to his institution); and receiving grant and fellowship support from AOSpine (money to his institution). Authors RAL/ZMS/EL/NJL/MC report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lee, N.J., Cerpa, M., Leung, E. et al. Do readmissions and reoperations adversely affect patient-reported outcomes following complex adult spinal deformity surgery at a minimum 2 years postoperative?. Spine Deform 9, 789–801 (2021). https://doi.org/10.1007/s43390-020-00235-w

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