title: Comparative analysis of clinical outcome and complications in primary versus revision adult scoliosis surgery.
abstract: METHODS
  A retrospective case comparison study.
  
  
  OBJECTIVE
  We compared clinical outcome and complications in adult patients who underwent primary (P) versus revision (R) scoliosis surgery.
  
  
  BACKGROUND
  There is a paucity of data comparing P versus R adult scoliosis patients with respect to their complication rates and clinical outcome.
  
  
  METHODS
  Assessment of 250 consecutive adult patients who underwent P versus R surgery for idiopathic or de novo scoliosis between 2002 and 2007, with a minimum 2-year follow-up, was performed.
  
  
  RESULTS
  There were 126 patients in the P group and 124 in the R group. Mean age at surgery (P = 51.2 vs. R = 51.6 years, P = 0.79), length of follow-up (P = 3.6 vs. R = 3.6 years, P = 0.94), comorbidities (P = 0.43), and smoking status (P = 0.98) were similar between the 2 groups. Body mass index (P = 25.5 vs. R = 27.4 kg/m, P = 0.01), number of final instrumented levels (P = 10.5 vs. R 12.1 levels, P = 0.00), fusion to the sacrum (P = 61.0% vs. R = 87.1%, P = 0.00), osteotomy (P = 14.3% vs. R = 54.9%, P = 0.00), length of surgery (P = 6.5 vs. R = 8.2 hours, P = 0.00), and estimated blood loss (P = 1072.1 vs. R = 1401.3 mL, P = 0.05) were different. Primary patients had significantly lower overall complications than revision patients (P = 45.2% vs. R = 58.2%, P = 0.042). Primary patients reported significantly higher preoperative and final clinical outcome measures in function, pain, and subscore SRS domains and ODI compared with revision patients (all P < 0.05). Patients older than 60 years of age, however, reported similar SRS and ODI scores between the 2 groups. The extent of surgical benefit patients received, that is, final minus preoperative score, was similar in all categories between the 2 groups.
  
  
  CONCLUSIONS
  Adult patients undergoing primary scoliosis surgery had significantly lower overall complications compared with revision patients. Primary patients reported higher preoperative and final clinical outcome measures than revision patients, although this difference disappeared in older patients. The benefit of surgery was similar between the 2 groups.
authors.affiliation: Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Woojin
authors.initials: W
authors.lastname: Cho
authors.forename: Lukas P
authors.initials: LP
authors.lastname: Zebala
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pahys
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Kang
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Yi
authors.forename: Christine R
authors.initials: CR
authors.lastname: Baldus
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000639:trends; D012189:Retrospective Studies; D012600:Scoliosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome