The impact of perioperative complications on clinical outcome in adult deformity surgery.
METHODS
Retrospective case-control series.


OBJECTIVE
The purpose of this study is to determine whether perioperative complications alter subsequent clinical outcome measures in adult spinal deformity surgery.


BACKGROUND
Increasingly, the benefit of surgical intervention is being evaluated based on patient reported outcomes and standardized health related quality of life (HRQOL) measures. As improvement or deterioration in HRQOL scores becomes a standard for clinical evaluation in adult spinal deformity, the correlation between HRQOL outcome scores and historic benchmarks, such as curve correction, sagittal balance, fusion healing, or the occurrence of a complication, must be clarified.


METHODS
This study analyzes a prospective multicenter data base for adult spinal deformity. Patients with major, minor, and no complications were matched using a logistic regression technique producing 46 patients in each group. Standardized outcome measures at baseline and at 1 year postop were compared.


RESULTS
Forty-seven major complications were reported in 46 patients. Sixty-two minor complications were noted in 46 patients. Comparison between the 3 complication groups revealed that 1-year postoperative outcome measures were not statistically different for the Scoliosis Research Society Outcomes Instrument, Medical Outcomes Short Form-36 (SF-12), Oswestry Disability Index, or Numerical Pain Scales. The only significant interaction was in the rate of change from preop to 1-year postop for the SF-12 general health subscale. For the group with major complications, SF-12 general health deteriorated by 2.1 points from preop to 1-year postop. During the same period, the group with minor complications experienced an improvement of 4.2 points and the group with no complications experienced an improvement of 1.5 points.


CONCLUSIONS
This study suggests that risk for minor complications may be a less substantial obstacle than previously assumed for surgical treatment in adult spinal deformity. In contrast, major complications were reported in approximately 10% of cases and adversely affected outcome as evidenced by the deterioration in SF-12 general health scores at 1 year after surgery.
Glassman
Steven D
SD
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA. tallgeyer@spinemds.com
Hamill
Christopher L
CL
Bridwell
Keith H
KH
Schwab
Frank J
FJ
Dimar
John R
JR
Lowe
Thomas G
TG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D016896:Treatment Outcome