title: The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery.
abstract: BACKGROUND
  To our knowledge, the effect of the staging regimen on the surgical outcome in patients undergoing combined anterior/posterior surgery for the treatment of spinal deformity has not been previously studied.
  
  
  OBJECTIVE
  To compare outcomes of anterior/posterior surgery for adult spinal deformity staged less than 21 days apart versus those 21 or more days apart.
  
  
  METHODS
  A retrospective comparison study.
  
  
  METHODS
  Patients aged 40 years or older who underwent combined anterior/posterior fusions for spinal deformities.
  
  
  METHODS
  Self-reported measures, physiological measures, and functional measures.
  
  
  METHODS
  We retrospectively reviewed prospectively collected data for 63 consecutive patients (50 females and 13 males) older than 40 years who underwent combined anterior/posterior fusions for spinal deformities and who had a minimum of 2-year follow-up. We divided them into those who had surgery staged less than 21 days apart (Group 1, N=29) and those who had surgery staged 21 or more days apart (Group 2, N=34). The groups were not statistically different in age; preoperative American Society of Anesthesiologists, Scoliosis Research Society-22 (SRS-22) patient questionnaire, and Oswestry Disability Index (ODI) scores; number of previous surgeries; number of levels fused; or total operative time. Hotelling t square test and the chi-squared test were used to compare clinical and radiographic parameters, complications, and functional outcomes between groups (significance, p<.05).
  
  
  RESULTS
  Compared with Group 1 patients, Group 2 (staged) patients had a lower total estimated blood loss (average, 4.5 L [range, 1.90-8.75 L] vs. 4 L [range, 1.8-10.1 L], respectively), fewer combined hospital days (average, 14 days [range, 7-70 days] vs. 12 days [range, 6-44 days], respectively), and fewer major complications (total, 10 [35%] vs. 6 [18%], respectively). Preoperative SRS-22 and ODI scores were significantly better in Group 2 than in Group 1 at 6 weeks (p<.001) and at final follow-up (p<.001), respectively.
  
  
  CONCLUSIONS
  For patients who require both anterior and posterior surgery for spinal deformity correction, staging the two procedures 21 or more days apart decreases total perioperative transfusion requirements although significantly improving functional outcomes.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Gjolaj
authors.forename: Mostafa H
authors.initials: MH
authors.lastname: El Dafrawy
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: David B
authors.initials: DB
authors.lastname: Cohen
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000002:abnormalities* / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome
keywords: Adult spinal deformity; Complications; Outcome; Scoliosis; Two-stage anterior and posterior