title: Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.
abstract: OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California;
authors.forename: Eric
authors.initials: E
authors.lastname: Klineberg
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and.
authors.forename: Renaud
authors.initials: R
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas;
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, and.
authors.forename: Themistocles S
authors.initials: TS
authors.lastname: Protopsaltis
authors.affiliation: Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
authors.forename: D Kojo
authors.initials: DK
authors.lastname: Hamilton
authors.affiliation: University of California San Diego School of Medicine, San Diego, California;
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Department of Orthopaedic Surgery, University of Calgary, Alberta, Canada;
authors.forename: Alex
authors.initials: A
authors.lastname: Soroceanu
authors.affiliation: Department of Orthopedic Surgery, Washington University, St. Louis, Missouri;
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.affiliation: Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado;
authors.forename: Breton
authors.initials: B
authors.lastname: Line
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California;
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Departments of 11 Orthopedic Surgery and.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.affiliation: Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon; and.
authors.forename: Robert
authors.initials: R
authors.lastname: Hart
authors.affiliation: Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado;
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Neurosurgery, University of California, San Francisco, California;
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013121:Spinal Curvatures / Q000453:epidemiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013131:Spine / Q000601:surgery; D055815:Young Adult
keywords: ASA = American Society of Anesthesiologists; ASD = adult spinal deformity; BMI = body mass index; CCI = Charlson Comorbidity Index; EBL = estimated blood loss; HRQOL = health-related quality of life; LL = lumbar lordosis; PCS = Physical Component Summary; PI = pelvic incidence; PI-LL = mismatch between pelvic incidence and lumbar lordosis; PJK = proximal junctional kyphosis; PT = pelvic tilt; SRS = Scoliosis Research Society; SVA = sagittal vertical axis; adult spinal deformity; complications; prospective; scoliosis; surgery