title: Does Planned Staging for Posterior-Only Vertebral Column Resections in Spinal Deformity Surgery Increase Perioperative Complications?
abstract: Propensity-matched case control.
  
  
  
  To compare the perioperative complication rate between single- and two-stage posterior-only VCRs (2-pVCR).
  
  
  
  A vertebral column resection (VCR) for severe spinal deformity is a technically challenging and lengthy procedure with a potentially high complication rate. Planned staging has an advantage of distributing operative time into 2 smaller, more manageable, intervals.
  
  
  
  Adult and pediatric spinal deformity patients undergoing a VCR were retrospectively identified from a single institution's surgical database from 1985 to 2013. Propensity scoring was used to match 2-pVCR and single-staged patients. Each group was matched for 15 preoperative risk factors including demographic, operative, and radiographic characteristics. Perioperative complications were defined as occurring within 2 months of initial surgery. Additionally, a binary logistic regression analysis was performed with complications as the outcome.
  
  
  
  A total of 183 consecutive patients were identified as undergoing a VCR, with 172 meeting the inclusion criteria (posterior-only). Forty-four patients underwent planned 2-pVCR whereas 124 had a single-staged VCR. Consistent with propensity-matching, no statistically significant difference between the single- and 2-pVCR cohorts existed for all matching parameters, except pulmonary function tests. There was no significant difference (p = .290) between complication rates for single-stage (12/35; 34%) and 2-pVCR (8/35; 23%) patients. Stepwise binary logistic regression analysis showed that age (p = .014; OR = 0.94, CI = 0.89-0.99) and body mass index (p = .030; OR = 1.13 CI = 1.01-1.26) influenced the occurrence of a complication.
  
  
  
  Planned staging of posterior-only VCRs does not increase the occurrence of perioperative complications in adult and pediatric spinal deformity patients.
  
  
  
  III (Propensity-matched case control).
authors.affiliation: Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Gum
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bumpass
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sugrue
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: Karikari
authors.affiliation: Orthopedic Group at Springfield Clinic, 800 North 1st Street, 1st Floor, Springfield, IL 62702, USA.
authors.forename: Ra'Kerry
authors.initials: R
authors.lastname: Rahman
authors.affiliation: Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. Electronic address: leah.carreon@nortonhealthcare.org.
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D019635:Neurosurgical Procedures; D061646:Operative Time; D019637:Orthopedic Procedures; D012600:Scoliosis / Q000601:surgery*
keywords: Adult deformity; Complications; Staged-surgery; Vertebral column resections