title: Postoperative Recovery After Adult Spinal Deformity Surgery: Comparative Analysis of Age in 149 Patients During 2-year Follow-up.
abstract: METHODS
  Retrospective review of a multicenter, prospective adult spinal deformity (ASD) database.
  
  
  OBJECTIVE
  We hypothesized that increased age and increased preoperative disability would negatively impact both the length of time needed to achieve maximal recovery and the amount of functional improvement achieved. In order to gauge the recovery process, a normalization process was used to calculate an integrated health state (IHS) during the 2-year postoperative period.
  
  
  BACKGROUND
  Elderly patients with ASD generally have worse baseline health-related quality of life (HRQOL) measures than younger patients. Current methods of reporting outcomes are limited, perhaps diminishing the health impact of the entire postoperative recovery experience.
  
  
  METHODS
  Inclusion criteria included 18 or more years and ASD. Patient groups: young (≤45 yr), middle (46-64), elderly (≥65) as well as by baseline Oswestry Disability Index (ODI) scores: MILD (0-30), MEDIUM (31-49), and HIGH (≥50). Collected HRQOL measures included ODI, Short Form-36(PCS/MCS), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1, and 2-year postoperative. All HRQOL measures were normalized to each patient's baseline scores. A 2-year IHS was calculated for each individual patient and the means were compared between groups.
  
  
  RESULTS
  149 patients were included (≤45:32, 46-64:67, ≥65:50). All groups significantly improved in all HRQOL at 2-year compared with baseline (P < 0.05) except for MCS, ODI, and SRS activity for the 45 or less group (P > 0.05). Normalized IHS HRQOL for young patients was worse than elderly for ODI, PCS, MCS, SRS activity, pain and total during the 2-year recovery period from index surgery. The MILD ODI group had significantly worse 2-year IHS values than the HIGH group for all HRQOL measured (P < 0.05) except SRS appearance and satisfaction (P > 0.05).
  
  
  CONCLUSIONS
  Contrary to our hypothesis, an IHS analysis suggested that the recovery process was significantly better for elderly patients than young patients and better for patients with high baseline disability.
  
  
  METHODS
  3.
authors.affiliation: *Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL †San Diego Center for Spinal Disorders, La Jolla, CA ‡Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA §Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR ¶Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA ∥Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY **Rocky Mountain Hospital for Children, Denver, CO ††Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA; and ‡‡Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.forename: Eric
authors.initials: E
authors.lastname: Klineberg
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.forename: Stacie
authors.initials: S
authors.lastname: Nguyen
authors.forename: Themistocles S
authors.initials: TS
authors.lastname: Protopsaltis
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010146:Pain / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D055815:Young Adult