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Risk factors of early complications after thoracic and lumbar spinal deformity surgery: a systematic review and meta-analysis

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Abstract

Purpose

To determine risk factors increasing susceptibility to early complications (intraoperative and postoperative within 6 weeks) associated with surgery to correct thoracic and lumbar spinal deformity.

Methods

We systematically searched the PubMed and EMBASE databases for studies published between January 1990 and September 2021. Observational studies evaluating predictors of early complications of thoracic and lumbar spinal deformity surgery were included. Pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated via the random effects model.

Results

Fifty-two studies representing 102,432 patients met the inclusion criteria. Statistically significant patient-related risk factors for early complications included neurological comorbidity (OR = 3.45, 95% CI 1.83–6.50), non-ambulatory status (OR = 3.37, 95% CI 1.96–5.77), kidney disease (OR = 2.80, 95% CI 1.80–4.36), American Society of Anesthesiologists score > 2 (OR = 2.23, 95% CI 1.76–2.84), previous spine surgery (OR = 1.98, 95% CI 1.41–2.77), pulmonary comorbidity (OR = 1.94, 95% CI 1.21–3.09), osteoporosis (OR = 1.60, 95% CI 1.17–2.20), cardiovascular diseases (OR = 1.46, 95% CI 1.20–1.78), hypertension (OR = 1.37, 95% CI 1.23–1.52), diabetes mellitus (OR = 1.84, 95% CI 1.30–2.60), preoperative Cobb angle (SMD = 0.43, 95% CI 0.29, 0.57), number of comorbidities (SMD = 0.41, 95% CI 0.12, 0.70), and preoperative lumbar lordotic angle (SMD = − 0.20, 95% CI − 0.35, − 0.06). Statistically significant procedure-related factors were fusion extending to the sacrum or pelvis (OR = 2.53, 95% CI 1.53–4.16), use of osteotomy (OR = 1.60, 95% CI 1.12–2.29), longer operation duration (SMD = 0.72, 95% CI 0.05, 1.40), estimated blood loss (SMD = 0.46, 95% CI 0.07, 0.85), and number of levels fused (SMD = 0.37, 95% CI 0.03, 0.70).

Conclusion

These data may contribute to development of a systematic approach aimed at improving quality-of-life and reducing complications in high-risk patients.

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Abbreviations

ASA:

American Society of Anesthesiologists

CI:

Confidence interval

DM:

Diabetes mellitus

LL:

Lumbar lordotic

NOS:

Newcastle–Ottawa quality assessment scale

OR:

Odds ratio

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PROSPERO:

International prospective register of systematic reviews

SD:

Standard deviation

SMD:

Standardized mean difference

UIV:

Upper instrumented vertebra

References

  1. Safaee MM, Ames CP, Smith JS (2020) Epidemiology and socioeconomic trends in adult spinal deformity care. Neurosurgery 87:25–32. https://doi.org/10.1093/neuros/nyz454

    Article  PubMed  Google Scholar 

  2. Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976) 30:1082–1085. https://doi.org/10.1097/01.brs.0000160842.43482.cd

    Article  PubMed  Google Scholar 

  3. McCarthy I, Hostin R, O’Brien M, Saigal R, Ames CP (2013) Health economic analysis of adult deformity surgery. Neurosurg Clin N Am 24:293–304. https://doi.org/10.1016/j.nec.2012.12.005

    Article  PubMed  Google Scholar 

  4. Smith JS, Kelly MP, Yanik EL, Baldus CR, Buell TJ, Lurie JD, Edwards C, Glassman SD, Lenke LG, Boachie-Adjei O, Buchowski JM, Carreon LY, Crawford CH, Errico TJ, Lewis SJ, Koski T, Parent S, Lafage V, Kim HJ, Ames CP, Bess S, Schwab FJ, Shaffrey CI, Bridwell KH (2021) Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 5-year follow-up: durability of outcomes and impact of treatment-related serious adverse events. J Neurosurg Spine. https://doi.org/10.3171/2020.9.SPINE201472

    Article  PubMed  PubMed Central  Google Scholar 

  5. Liu S, Schwab F, Smith JS, Klineberg E, Ames CP, Mundis G, Hostin R, Kebaish K, Deviren V, Gupta M, Boachie-Adjei O, Hart RA, Bess S, Lafage V (2014) Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Ochsner J 14:67–77

    PubMed  PubMed Central  Google Scholar 

  6. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976) 34:2171–2178. https://doi.org/10.1097/BRS.0b013e3181a8fdc8

    Article  PubMed  Google Scholar 

  7. Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM Jr, Errico TJ, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Soroceanu A, Kelly MP, Line B, Gupta M, Deviren V, Hart R, Burton DC, Bess S, Ames CP, International Spine Study G (2016) Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25:1–14. https://doi.org/10.3171/2015.11.SPINE151036

    Article  PubMed  Google Scholar 

  8. Weiss HR, Goodall D (2008) Rate of complications in scoliosis surgery–a systematic review of the Pub Med literature. Scoliosis 3:9. https://doi.org/10.1186/1748-7161-3-9

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sharma S, Wu C, Andersen T, Wang Y, Hansen ES, Bunger CE (2013) Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 22:1230–1249. https://doi.org/10.1007/s00586-012-2542-2

    Article  PubMed  Google Scholar 

  10. Smith C, Lamba N, Ou Z, Vo QA, Araujo-Lama L, Lim S, Joshi D, Doucette J, Papatheodorou S, Tafel I, Aglio LS, Smith TR, Mekary RA, Zaidi H (2019) The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis. J Spine Surg 5:223–235. https://doi.org/10.21037/jss.2019.03.06

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW Jr, Perra JH, Boachie-Adjei O, Shaffrey CI (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36:E593-597. https://doi.org/10.1097/BRS.0b013e3182059bfd

    Article  PubMed  Google Scholar 

  12. Mok JM, Cloyd JM, Bradford DS, Hu SS, Deviren V, Smith JA, Tay B, Berven SH (2009) Reoperation after primary fusion for adult spinal deformity: rate, reason, and timing. Spine (Phila Pa 1976) 34:832–839. https://doi.org/10.1097/BRS.0b013e31819f2080

    Article  PubMed  Google Scholar 

  13. Buell TJ, Smith JS, Shaffrey CI, Kim HJ, Klineberg EO, Lafage V, Lafage R, Protopsaltis TS, Passias PG, Mundis GM, Eastlack RK, Deviren V, Kelly MP, Daniels AH, Gum JL, Soroceanu A, Hamilton DK, Gupta MC, Burton DC, Hostin RA, Kebaish KM, Hart RA, Schwab FJ, Bess S, Ames CP (2021) Operative treatment of severe scoliosis in symptomatic adults: multicenter assessment of outcomes and complications with minimum 2-year follow-up. Neurosurgery 89:1012–1026. https://doi.org/10.1093/neuros/nyab352

    Article  PubMed  Google Scholar 

  14. Pateder DB, Gonzales RA, Kebaish KM, Antezana DF, Cohen DB, Chang JY, Kostuik JP (2008) Pulmonary embolism after adult spinal deformity surgery. Spine (Phila Pa 1976) 33:301–305. https://doi.org/10.1097/BRS.0b013e31816245e1

    Article  PubMed  Google Scholar 

  15. Zuckerman SL, Lakomkin N, Smith JS, Shaffrey CI, Devin CJ (2018) Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery. J Spine Surg (Hong Kong) 4:333–341. https://doi.org/10.21037/jss.2018.05.28

    Article  Google Scholar 

  16. Worley N, Marascalchi B, Jalai CM, Yang S, Diebo B, Vira S, Boniello A, Lafage V, Passias PG (2016) Predictors of inpatient morbidity and mortality in adult spinal deformity surgery. Eur Spine J 25:819–827. https://doi.org/10.1007/s00586-015-4104-x

    Article  PubMed  Google Scholar 

  17. 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) 32:2764–2770. https://doi.org/10.1097/BRS.0b013e31815a7644

    Article  PubMed  Google Scholar 

  18. Yeramaneni S, Robinson C, Hostin R (2016) Impact of spine surgery complications on costs associated with management of adult spinal deformity. Curr Rev Musculoskelet Med 9:327–332. https://doi.org/10.1007/s12178-016-9352-9

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schwab FJ, Hawkinson N, Lafage V, Smith JS, Hart R, Mundis G, Burton DC, Line B, Akbarnia B, Boachie-Adjei O, Hostin R, Shaffrey CI, Arlet V, Wood K, Gupta M, Bess S, Mummaneni PV, International Spine Study G (2012) Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients. Eur Spine J 21:2603–2610. https://doi.org/10.1007/s00586-012-2370-4

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nunez-Pereira S, Pellise F, Vila-Casademunt A, Alanay A, Acaraglou E, Obeid I, Sanchez Perez-Grueso FJ, Kleinstuck F, Group EESS (2019) Impact of resolved early major complications on 2-year follow-up outcome following adult spinal deformity surgery. Eur Spine J 28:2208–2215. https://doi.org/10.1007/s00586-019-06041-x

    Article  PubMed  Google Scholar 

  21. Good CR, Auerbach JD, O’Leary PT, Schuler TC (2011) Adult spine deformity. Curr Rev Musculoskelet Med 4:159–167. https://doi.org/10.1007/s12178-011-9101-z

    Article  PubMed  PubMed Central  Google Scholar 

  22. Scheer JK, Smith JS, Schwab F, Lafage V, Shaffrey CI, Bess S, Daniels AH, Hart RA, Protopsaltis TS, Mundis GM Jr, Sciubba DM, Ailon T, Burton DC, Klineberg E, Ames CP, International Spine Study G (2017) Development of a preoperative predictive model for major complications following adult spinal deformity surgery. J Neurosurg Spine 26:736–743. https://doi.org/10.3171/2016.10.SPINE16197

    Article  PubMed  Google Scholar 

  23. Burton DC, Sethi RK, Wright AK, Daniels AH, Ames CP, Reid DB, Klineberg EO, Harper R, Mundis GM, Hlubek RJ, Bess S, Hart RA, Kelly MP, Lenke LG (2019) The role of potentially modifiable factors in a standard work protocol to decrease complications in adult spinal deformity surgery: a systematic review, part 1. Spine Deform 7:669–683. https://doi.org/10.1016/j.jspd.2019.04.003

    Article  PubMed  Google Scholar 

  24. Kang GR, Suh SW, Lee IO (2011) Preoperative predictors of postoperative pulmonary complications in neuromuscular scoliosis. J Orthop Sci 16:139–147. https://doi.org/10.1007/s00776-011-0028-4

    Article  PubMed  Google Scholar 

  25. Pugely AJ, Martin CT, Gao Y, Ilgenfritz R, Weinstein SL (2014) The incidence and risk factors for short-term morbidity and mortality in pediatric deformity spinal surgery: an analysis of the NSQIP pediatric database. Spine (Phila Pa 1976) 39:1225–1234. https://doi.org/10.1097/BRS.0000000000000365

    Article  PubMed  Google Scholar 

  26. Xie JM, Zhang Y, Wang YS, Bi N, Zhao Z, Li T, Yang H (2014) The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J 23:149–156. https://doi.org/10.1007/s00586-013-2793-6

    Article  PubMed  Google Scholar 

  27. Lee NJ, Kothari P, Kim JS, Shin JI, Phan K, Di Capua J, Somani S, Leven DM, Guzman JZ, Cho SK (2017) Early complications and outcomes in adult spinal deformity surgery: an NSQIP study based on 5803 patients. Glob Spine J 7:432–440. https://doi.org/10.1177/2192568217699384

    Article  Google Scholar 

  28. Fanous AA, Kolcun JPG, Brusko GD, Paci M, Ghobrial GM, Nakhla J, Eleswarapu A, Lebwohl NH, Green BA, Gjolaj JP (2019) Surgical site infection as a risk factor for long-term instrumentation failure in patients with spinal deformity: a retrospective cohort study. World Neurosurg 132:e514–e519. https://doi.org/10.1016/j.wneu.2019.08.088

    Article  PubMed  Google Scholar 

  29. Li XJ, Lenke LG, Jin L, Tuchman A, Tan LA, Lehman RA, Cerpa M (2020) Surgeon-specific risk stratification model for early complications after complex adult spinal deformity surgery. Spine Deform 8:97–104. https://doi.org/10.1007/s43390-020-00047-y

    Article  PubMed  Google Scholar 

  30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hrobjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906. https://doi.org/10.1016/j.ijsu.2021.105906

    Article  PubMed  Google Scholar 

  31. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  32. Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 11:193–206. https://doi.org/10.1037/1082-989X.11.2.193

    Article  PubMed  Google Scholar 

  33. Al-Iede MM, Al-Zayadneh E, Bridge C, Alqutawneh B, Waters K (2020) Risk factors for postoperative pulmonary complications in children with severely compromised pulmonary function secondary to severe scoliosis. Pediatr Pulmonol 55:2782–2790. https://doi.org/10.1002/ppul.24997

    Article  PubMed  Google Scholar 

  34. Chan L, Li Y, Hai Y, Liu Y, Zhang Y (2021) Risk factors of unintended return to the operating room in adult spinal deformity. J Orthop Surg Res 16:240. https://doi.org/10.1186/s13018-021-02385-7

    Article  PubMed  PubMed Central  Google Scholar 

  35. Chen J, Shao X-x, Sui W-y, Yang J-f, Deng Y-l, Xu J, Huang Z-f, Yang J-l (2020) Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases. BMC Neurol 20:433. https://doi.org/10.1186/s12883-020-02012-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Choi WK, Lee KY, Lee SR (2007) Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976) 32:2232–2237. https://doi.org/10.1097/BRS.0b013e31814b2d3c

    Article  PubMed  Google Scholar 

  37. Cho SK, Bridwell KH, Lenke LG, Yi JS, Pahys JM, Zebala LP, Kang MM, Cho W, Baldus CR (2012) Major complications in revision adult deformity surgery: risk factors and clinical outcomes with 2- to 7-year follow-up. Spine (Phila Pa 1976) 37:489–500. https://doi.org/10.1097/BRS.0b013e3182217ab5

    Article  PubMed  Google Scholar 

  38. Cho W, Mason JR, Smith JS, Shimer AL, Wilson AS, Shaffrey CI, Shen FH, Novicoff WM, Fu KM, Heller JE, Arlet V (2013) Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine 19:445–453. https://doi.org/10.3171/2013.6.SPINE121129

    Article  PubMed  Google Scholar 

  39. De la Garza RR, Passias PG, Schwab F, Bydon A, Lafage V, Sciubba DM (2017) Incidence, risk factors, and mortality of reintubation in adult spinal deformity surgery. Clin Spine Surg 30:E896–E900. https://doi.org/10.1097/BSD.0000000000000404

    Article  Google Scholar 

  40. De la Garza-Ramos R, Samdani AF, Sponseller PD, Ain MC, Miller NR, Shaffrey CI, Sciubba DM (2016) Visual loss after corrective surgery for pediatric scoliosis: incidence and risk factors from a nationwide database. Spine J 16:516–522. https://doi.org/10.1016/j.spinee.2015.12.031

    Article  PubMed  Google Scholar 

  41. Di Capua J, Somani S, Kim JS, Leven DM, Lee NJ, Kothari P, Cho SK (2017) Hospital-acquired conditions in adult spinal deformity surgery: predictors for hospital-acquired conditions and other 30-day postoperative outcomes. Spine (Phila Pa 1976) 42:595–602. https://doi.org/10.1097/BRS.0000000000001840

    Article  PubMed  Google Scholar 

  42. Ding JZ, Kong C, Sun XY, Lu SB (2019) Perioperative complications and risk factors in degenerative lumbar scoliosis surgery for patients older than 70 years Of age. Clin Interv Aging 14:2195–2203. https://doi.org/10.2147/cia.S218204

    Article  PubMed  PubMed Central  Google Scholar 

  43. Dong Y, Tang N, Wang S, Zhang J, Zhao H (2021) Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center. BMC Musculoskelet Disord 22:13. https://doi.org/10.1186/s12891-020-03869-z

    Article  PubMed  PubMed Central  Google Scholar 

  44. Elsamadicy AA, Adogwa O, Reddy GB, Sergesketter A, Warwick H, Jones T, Cheng J, Bagley CA, Karikari IO (2017) Risk factors and independent predictors of 30-day readmission for altered mental status after elective spine surgery for spine deformity: a single-institutional study of 1090 patients. World Neurosurg 101:270–274. https://doi.org/10.1016/j.wneu.2017.02.001

    Article  PubMed  Google Scholar 

  45. Farah K, Lubiato A, Meyer M, Prost S, Ognard J, Blondel B, Fuentes S (2021) Surgical site infection following surgery for spinal deformity: about 102 patients. Neurochirurgie 67:152–156. https://doi.org/10.1016/j.neuchi.2020.10.006

    Article  CAS  PubMed  Google Scholar 

  46. Feng F, Tan H, Li X, Qiao Y, Chen C, Lin Y, Li Z, Shen J (2018) Incidence and risk factors of acute pancreatitis after scoliosis surgery: a prospective study. Spine (Phila Pa 1976) 43:630–636. https://doi.org/10.1097/BRS.0000000000002389

    Article  PubMed  Google Scholar 

  47. Hayashi K, Terai H, Toyoda H, Suzuki A, Hoshino M, Tamai K, Ohyama S, Nakamura H (2017) Incidence of pleural fluid and its associated risk factors after posterior spinal fusion in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 42:603–609. https://doi.org/10.1097/BRS.0000000000001861

    Article  PubMed  Google Scholar 

  48. Kabirian N, Akbarnia BA, Pawelek JB, Alam M, Mundis GM Jr, Acacio R, Thompson GH, Marks DS, Gardner A, Sponseller PD, Skaggs DL, Growing Spine Study G (2014) Deep surgical site infection following 2344 growing-rod procedures for early-onset scoliosis: risk factors and clinical consequences. J Bone Joint Surg Am 96:e128. https://doi.org/10.2106/JBJS.M.00618

    Article  PubMed  Google Scholar 

  49. Kim HJ, Iyer S, Zebala LP, Kelly MP, Sciubba D, Protopsaltis TS, Gupta M, Neuman BJ, Mundis GM, Ames CP, Smith JS, Hart R, Burton D, Klineberg EO, International Spine Study G (2017) Perioperative neurologic complications in adult spinal deformity surgery: incidence and risk factors in 564 patients. Spine (Phila Pa 1976) 42:420–427. https://doi.org/10.1097/BRS.0000000000001774

    Article  PubMed  Google Scholar 

  50. Laplaza FJ, Widmann RF, Fealy S, Moustafellos E, Illueca M, Burke SW, Boachie-Adjei O (2002) Pancreatitis after surgery in adolescent idiopathic scoliosis: incidence and risk factors. J Pediatr Orthop 22:80–83

    Article  PubMed  Google Scholar 

  51. Lee NJ, Shin JI, Kothari P, Kim JS, Leven DM, Steinberger J, Guzman JZ, Skovrlj B, Caridi JM, Cho SK (2017) Incidence, impact, and risk factors for 30-day wound complications following elective adult spinal deformity surgery. Glob Spine J 7:417–424. https://doi.org/10.1177/2192568217699378

    Article  Google Scholar 

  52. Li Z, Shen J, Qiu G, Yu H, Wang Y, Zhang J, Zhao H, Zhao Y, Li S, Weng X, Liang J, Zhao L (2014) Unplanned reoperation within 30 days of fusion surgery for spinal deformity. PLoS ONE 9:e87172–e87172. https://doi.org/10.1371/journal.pone.0087172

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Liang J, Li S, Xu D, Zhuang Q, Ren Z, Chen X, Gao N (2015) Risk factors for predicting complications associated with growing rod surgery for early-onset scoliosis. Clin Neurol Neurosurg 136:15–19. https://doi.org/10.1016/j.clineuro.2015.05.026

    Article  PubMed  Google Scholar 

  54. Liang J, Qiu G, Shen J, Zhang J, Wang Y, Li S, Zhao H (2010) Predictive factors of postoperative pulmonary complications in scoliotic patients with moderate or severe pulmonary dysfunction. J Spinal Disord Tech 23:388–392. https://doi.org/10.1097/BSD.0b013e3181b55ff4

    Article  PubMed  Google Scholar 

  55. Martin CT, Pugely AJ, Gao Y, Weinstein SL (2015) Causes and risk factors for 30-day unplanned readmissions after pediatric spinal deformity surgery. Spine (Phila Pa 1976) 40:238–246. https://doi.org/10.1097/BRS.0000000000000730

    Article  PubMed  Google Scholar 

  56. Ohba T, Koyama K, Oba H, Oda K, Tanaka N, Haro H (2020) Clinical importance, incidence and risk factors for the development of postoperative ileus following adult spinal deformity surgery. Glob Spine J. https://doi.org/10.1177/2192568220976562

    Article  Google Scholar 

  57. Qiao J, Xiao L, Sun X, Shi B, Liu Z, Xu L, Zhu Z, Qian B, Qiu Y (2018) Vertebral subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications. Eur Spine J 27:630–635. https://doi.org/10.1007/s00586-017-5285-2

    Article  PubMed  Google Scholar 

  58. Qiu Y, Wang S, Wang B, Yu Y, Zhu F, Zhu Z (2008) Incidence and risk factors of neurological deficits of surgical correction for scoliosis: analysis of 1373 cases at one Chinese institution. Spine (Phila Pa 1976) 33:519–526. https://doi.org/10.1097/BRS.0b013e3181657d93

    Article  PubMed  Google Scholar 

  59. Ramo BA, Roberts DW, Tuason D, McClung A, Paraison LE, Moore HG, Sucato DJ (2014) Surgical site infections after posterior spinal fusion for neuromuscular scoliosis: a thirty-year experience at a single institution. J Bone Joint Surg Am 96:2038–2048. https://doi.org/10.2106/jbjs.N.00277

    Article  PubMed  Google Scholar 

  60. Roddy E, Diab M (2017) Rates and risk factors associated with unplanned hospital readmission after fusion for pediatric spinal deformity. Spine J 17:369–379. https://doi.org/10.1016/j.spinee.2016.10.008

    Article  PubMed  Google Scholar 

  61. Simon MJK, Halm HFH, Quante M (2018) Perioperative complications after surgical treatment in degenerative adult de novo scoliosis. BMC Musculoskelet Disord 19:10. https://doi.org/10.1186/s12891-017-1925-2

    Article  PubMed  PubMed Central  Google Scholar 

  62. Soroceanu A, Burton DC, Oren JH, Smith JS, Hostin R, Shaffrey CI, Akbarnia BA, Ames CP, Errico TJ, Bess S, Gupta MC, Deviren V, Schwab FJ, Lafage V, International Spine Study G (2016) Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine (Phila Pa 1976) 41:1718–1723. https://doi.org/10.1097/BRS.0000000000001636

    Article  PubMed  Google Scholar 

  63. Tang H, Zhu J, Ji F, Wang S, Xie Y, Fei H (2014) Risk factors for postoperative complication after spinal fusion and instrumentation in degenerative lumbar scoliosis patients. J Orthop Surg Res 9:15. https://doi.org/10.1186/1749-799X-9-15

    Article  PubMed  PubMed Central  Google Scholar 

  64. Toll BJ, Samdani AF, Janjua MB, Gandhi S, Pahys JM, Hwang SW (2018) Perioperative complications and risk factors in neuromuscular scoliosis surgery. J Neurosurg Pediatr 22:207–213. https://doi.org/10.3171/2018.2.PEDS17724

    Article  PubMed  Google Scholar 

  65. Wang H, Zhang Z, Qiu G, Zhang J, Shen J (2018) Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study. BMC Musculoskelet Disord 19:242. https://doi.org/10.1186/s12891-018-2148-x

    Article  PubMed  PubMed Central  Google Scholar 

  66. Wang Y, Hai Y, Liu Y, Guan L, Liu T (2019) A predictive scoring system for pulmonary complications after posterior instrumentation and fusion for non-degenerative scoliosis. Clin Neurol Neurosurg 182:49–52. https://doi.org/10.1016/j.clineuro.2019.04.024

    Article  PubMed  Google Scholar 

  67. Watanabe K, Yamaguchi T, Suzuki S, Suzuki T, Nakayama K, Demura S, Taniguchi Y, Yamamoto T, Sugawara R, Sato T, Fujiwara K, Murakami H, Akazawa T, Kakutani K, Hirano T, Yanagida H, Watanabe K, Matsumoto M, Uno K, Kotani T, Takeshita K, Ohara T, Kawakami N, Japan Spinal Deformity Institute Study G (2021) Surgical site infection following primary definitive fusion for pediatric spinal deformity: a multicenter study of rates, risk factors, and pathogens. Spine (Phila Pa 1976) 46:1097–1104. https://doi.org/10.1097/BRS.0000000000003960

    Article  PubMed  Google Scholar 

  68. Wu L, Zhang X-n, Wang Y-s, Liu Y-z, Hai Y (2019) Risk factors for pulmonary complications after posterior spinal instrumentation and fusion in the treatment of congenital scoliosis: a case-control study. BMC Musculoskelet Disord 20:331. https://doi.org/10.1186/s12891-019-2708-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Wu N, Shao J, Zhang Z, Wang S, Li Z, Zhao S, Yang Y, Liu L, Yu C, Liu S, Zhao Z, Du Y, Zhang Y, Wang L, Zhao Y, Yu K, Zhao H, Shen J, Qiu G, Wu Z, Zhang TJ, Deciphering Disorders Involving S, study CO (2021) Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis. BMC Musculoskelet Disord 22:483. https://doi.org/10.1186/s12891-021-04361-y

    Article  PubMed  PubMed Central  Google Scholar 

  70. Wulff I, Duah HO, Osei Tutu H, Ofori-Amankwah G, Yankey KP, Owiredu MA, Bidemi Yahaya H, Akoto H, Oteng-Yeboah A, Boachie-Adjei O (2021) Postoperative pulmonary complications in complex pediatric and adult spine deformity: a retrospective review of consecutive patients treated at a single site in West Africa. Glob Spine J 11:1208–1214. https://doi.org/10.1177/2192568220942482

    Article  Google Scholar 

  71. Yagi M, Michikawa T, Hosogane N, Fujita N, Okada E, Suzuki S, Tsuji O, Nagoshi N, Asazuma T, Tsuji T, Nakamura M, Matsumoto M, Watanabe K (2019) Risk, recovery, and clinical impact of neurological complications in adult spinal deformity surgery. Spine (Phila Pa 1976) 44:1364–1370. https://doi.org/10.1097/BRS.0000000000003080

    Article  PubMed  Google Scholar 

  72. Yang Y, Yang M, Zhao J, Zhao Y, Yang C, Li M (2019) Postoperative shoulder imbalance in adolescent idiopathic scoliosis: risk factors and predictive index. Eur Spine J 28:1331–1341. https://doi.org/10.1007/s00586-019-05933-2

    Article  PubMed  Google Scholar 

  73. Yao Z, Li H, Zhang X, Li C, Qi X (2018) Incidence and risk factors for instrumentation-related complications after scoliosis surgery in pediatric patients with NF-1. Spine (Phila Pa 1976) 43:1719–1724. https://doi.org/10.1097/BRS.0000000000002720

    Article  PubMed  Google Scholar 

  74. Yin S, Tao H, Du H, Feng C, Yang Y, Yang W, Duan C (2018) Postoperative pulmonary complications following posterior spinal instrumentation and fusion for congenital scoliosis. PLoS ONE 13:e0207657. https://doi.org/10.1371/journal.pone.0207657

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Yoshida G, Hasegawa T, Yamato Y, Kobayashi S, Oe S, Banno T, Mihara Y, Arima H, Ushirozako H, Yasuda T, Togawa D, Matsuyama Y (2018) Predicting perioperative complications in adult spinal deformity surgery using a simple sliding scale. Spine (Phila Pa 1976) 43:562–570. https://doi.org/10.1097/brs.0000000000002411

    Article  PubMed  Google Scholar 

  76. Hyun SJ, Jung JM (2018) Spinal deformity surgery: it becomes an essential part of neurosurgery. J Korean Neurosurg Soc 61:661–668. https://doi.org/10.3340/jkns.2018.0150

    Article  PubMed  PubMed Central  Google Scholar 

  77. Steinberger J, York P, Virk S, Kim HJ (2020) Advances in spinal fusion strategies in adult deformity surgery. HSS J 16:195–199. https://doi.org/10.1007/s11420-020-09751-x

    Article  PubMed  PubMed Central  Google Scholar 

  78. Smith JS, Shaffrey CI, Bess S, Shamji MF, Brodke D, Lenke LG, Fehlings MG, Lafage V, Schwab F, Vaccaro AR, Ames CP (2017) Recent and emerging advances in spinal deformity. Neurosurgery 80:S70–S85. https://doi.org/10.1093/neuros/nyw048

    Article  PubMed  Google Scholar 

  79. Sciubba D, Jain A, Kebaish KM, Neuman BJ, Daniels AH, Passias PG, Kim HJ, Protopsaltis TS, Scheer JK, Smith JS, Hamilton K, Bess S, Klineberg EO, Ames CP (2021) Development of a preoperative adult spinal deformity comorbidity score that correlates with common quality and value metrics: length of stay, major complications, and patient-reported outcomes. Glob Spine J 11:146–153. https://doi.org/10.1177/2192568219894951

    Article  Google Scholar 

  80. 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) 32:2238–2244. https://doi.org/10.1097/BRS.0b013e31814cf24a

    Article  PubMed  Google Scholar 

  81. Berry JG, Glotzbecker M, Rodean J, Leahy I, Hall M, Ferrari L (2017) Comorbidities and complications of spinal fusion for scoliosis. Pediatrics. https://doi.org/10.1542/peds.2016-2574

    Article  PubMed  PubMed Central  Google Scholar 

  82. Epstein NE (2017) Predominantly negative impact of diabetes on spinal surgery: a review and recommendation for better preoperative screening. Surg Neurol Int 8:107. https://doi.org/10.4103/sni.sni_101_17

    Article  PubMed  PubMed Central  Google Scholar 

  83. Howell SJ, Sear JW, Foex P (2004) Hypertension, hypertensive heart disease and perioperative cardiac risk. Br J Anaesth 92:570–583. https://doi.org/10.1093/bja/aeh091

    Article  CAS  PubMed  Google Scholar 

  84. Aquino JA, Baldoni AO, Di Lorenzo OC, Cardoso CS, de Figueiredo RC, Sanches C (2019) Pharmacotherapeutic empowerment and its effectiveness in glycemic control in patients with Diabetes Mellitus. Diabetes Metab Syndr 13:137–142. https://doi.org/10.1016/j.dsx.2018.08.002

    Article  PubMed  Google Scholar 

  85. Yancey R (2018) Anesthetic management of the hypertensive patient: part II. Anesth Prog 65:206–213. https://doi.org/10.2344/anpr-65-03-17

    Article  PubMed  PubMed Central  Google Scholar 

  86. Pantoja S, Molina M (2019) Surgeon management of osteoporosis in instrumented spine surgery: AOSpine latin America survey. Glob Spine J 9:169–172. https://doi.org/10.1177/2192568218785369

    Article  Google Scholar 

  87. Chin DK, Park JY, Yoon YS, Kuh SU, Jin BH, Kim KS, Cho YE (2007) Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease. Osteoporos Int 18:1219–1224. https://doi.org/10.1007/s00198-007-0370-8

    Article  CAS  PubMed  Google Scholar 

  88. Yagi M, Ohne H, Konomi T, Fujiyoshi K, Kaneko S, Komiyama T, Takemitsu M, Yato Y, Machida M, Asazuma T (2016) Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity. Osteoporos Int 27:3495–3502. https://doi.org/10.1007/s00198-016-3676-6

    Article  CAS  PubMed  Google Scholar 

  89. Tevis SE, Kennedy GD (2013) Postoperative complications and implications on patient-centered outcomes. J Surg Res 181:106–113. https://doi.org/10.1016/j.jss.2013.01.032

    Article  PubMed  PubMed Central  Google Scholar 

  90. Yagi M, Fujita N, Okada E, Tsuji O, Nagoshi N, Tsuji T, Asazuma T, Nakamura M, Matsumoto M, Watanabe K (2018) Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders. Spine (Phila Pa 1976) 43:1259–1267. https://doi.org/10.1097/BRS.0000000000002596

    Article  PubMed  Google Scholar 

  91. Bjure J, Grimby G, Kasalicky J, Lindh M, Nachemson A (1970) Respiratory impairment and airway closure in patients with untreated idiopathic scoliosis. Thorax 25:451–456. https://doi.org/10.1136/thx.25.4.451

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Maruyama T, Takeshita K (2009) Surgery for idiopathic scoliosis: currently applied techniques. Clin Med Pediatr 3:39–44. https://doi.org/10.4137/cmped.s2117

    Article  PubMed  PubMed Central  Google Scholar 

  93. Sparrey CJ, Bailey JF, Safaee M, Clark AJ, Lafage V, Schwab F, Smith JS, Ames CP (2014) Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration. Neurosurg Focus 36:E1. https://doi.org/10.3171/2014.1.FOCUS13551

    Article  PubMed  Google Scholar 

  94. Zou L, Liu J, Lu H (2019) Characteristics and risk factors for proximal junctional kyphosis in adult spinal deformity after correction surgery: a systematic review and meta-analysis. Neurosurg Rev 42:671–682. https://doi.org/10.1007/s10143-018-1004-7

    Article  PubMed  Google Scholar 

  95. Ramsey T, Ostrowski T, Curran K, Mouzakes J, Gildener-Leapman N (2021) Association of surrogate objective measures with work relative value units. Ochsner J 21:371–380. https://doi.org/10.31486/toj.20.0153

    Article  PubMed  PubMed Central  Google Scholar 

  96. Schoenfeld AJ, Carey PA, Cleveland AW 3rd, Bader JO, Bono CM (2013) Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5887 patients. Spine J 13:1171–1179. https://doi.org/10.1016/j.spinee.2013.02.071

    Article  PubMed  Google Scholar 

  97. Rawicki N, Dowdell JE, Sandhu HS (2021) Current state of navigation in spine surgery. Ann Transl Med 9:85. https://doi.org/10.21037/atm-20-1335

    Article  PubMed  PubMed Central  Google Scholar 

  98. Lak AM, Abunimer AM, Goedmakers CMW, Aglio LS, Smith TR, Makhni M, Mekary RA, Zaidi HA (2021) Single- versus dual-attending surgeon approach for spine deformity: a systematic review and meta-analysis. Oper Neurosurg (Hagerstown) 20:233–241. https://doi.org/10.1093/ons/opaa393

    Article  PubMed  Google Scholar 

  99. Januszewski J, Vivas AC, Uribe JS (2018) Limitations and complications of minimally invasive spinal surgery in adult deformity. Ann Transl Med 6:109. https://doi.org/10.21037/atm.2018.01.29

    Article  PubMed  PubMed Central  Google Scholar 

  100. Rampersaud YR, Moro ER, Neary MA, White K, Lewis SJ, Massicotte EM, Fehlings MG (2006) Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine (Phila Pa 1976) 31:1503–1510. https://doi.org/10.1097/01.brs.0000220652.39970.c2

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Paul H. Dressel BFA for formatting the illustrations and Carrie Owens MSILS and Debra J. Zimmer for editorial support.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA

    Cathleen C. Kuo, Alexander O. Aguirre & Marissa Kruk

  2. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Mohamed A. R. Soliman, Ryan M. Hess, Elizabeth M. Nyabuto, Asham Khan, Patrick K. Jowdy, John Pollina & Jeffrey P. Mullin

  3. Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA

    Mohamed A. R. Soliman, Ryan M. Hess, Elizabeth M. Nyabuto, Asham Khan, Patrick K. Jowdy, John Pollina & Jeffrey P. Mullin

  4. Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed A. R. Soliman

  5. SUNY Upstate Medical University, Syracuse, NY, USA

    Dennis Youngs

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  1. Cathleen C. Kuo
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Contributions

Authors Cathleen C. Kuo, Mohamed A.R. Soliman, John Pollina, and Jeffrey P. Mullin contributed to the study conception and design. Acquisition of data was performed by Cathleen C. Kuo, Alexander O. Aguirre, Dennis Youngs, and Marissa Kruk. Analysis and interpretation of the data were performed by Cathleen C. Kuo, Mohamed A.R. Soliman, Ryan M. Hess, Elizabeth M. Nyabuto, Asham Khan, Patrick K. Jowdy, John Pollina, and Jeffrey P. Mullin. Statistical analysis was performed by Cathleen C. Kuo. The first draft of the manuscript was written by Cathleen C. Kuo, Mohamed A.R. Soliman, and Alexander O. Aguirre. All authors participated in critically revising previous versions of the manuscript and review and approval of the final manuscript. The study was supervised by John Pollina and Jeffrey P. Mullin.

Corresponding author

Correspondence to Jeffrey P. Mullin.

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Conflict of interest

Dr. Mullin receives research funding from AOSpine North America (AOSNA) and the Research Committee Award #87,639; and from Medtronic External Research Program Health Professionals, ERP ID#2020–12,271. Dr. Pollina is involved with surgical training for Medtronic and serves as a consultant for and receives royalties from ATEC Spine. Dr. Khan received a research grant from the Scoliosis Research Society to study scoliosis in Chiari patients. All other authors have no personal, financial, or institutional interest in the materials or devices described in this manuscript.

Ethical approval

The University at Buffalo Institutional Review Board determined that this study was not research involving human subjects and review and approval were not required.

Previous presentation

Oral presentation: Spine Summit 2022; Las Vegas, Nevada; February 26, 2022.

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Kuo, C.C., Soliman, M.A.R., Aguirre, A.O. et al. Risk factors of early complications after thoracic and lumbar spinal deformity surgery: a systematic review and meta-analysis. Eur Spine J 32, 899–913 (2023). https://doi.org/10.1007/s00586-022-07486-3

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