title: Unplanned Reoperations Affect Long-Term Outcomes in Adult Spinal Deformity Patients Undergoing Long Fusions to the Sacrum.
abstract: METHODS
  Retrospective clinical cohort study.
  
  
  OBJECTIVE
  To compare the long-term complications and outcomes scores of primary and revision surgeries for adult spinal deformity of patients treated with long fusions to the sacrum.
  
  
  BACKGROUND
  Long fusions in patients with adult spinal deformity are fraught with complications and the need for reoperation that can significantly impact patient health-related quality of life.
  
  
  METHODS
  Data from 134 consecutive patients who underwent spinal fusion from the thoracic spine to the sacropelvis and had a minimum of 5-year follow-up were analyzed. Patients were classified as primary surgery (PS) and index revision (IR) surgery; they were then subdivided based on whether they returned to the operating room (RTO) or not (NRTO). RTO complications were classified as 1) infection, 2) neurologic, 3) fusion status, 4) implants, and 5) global alignment and stratified as <6 months, <2 years, and >2 years. Final Scoliosis Research Society Patient Questionnaire (SRS 22r) and Oswestry Disability Index (ODI) scores were compared between subgroups.
  
  
  RESULTS
  Seventy-one PS and 63 IR were included in the analysis. Mean age at surgery was 54.9 years (30-78), mean follow-up 5.8 years (4.9-12.8). RTO rates were 21.1% and 34.9%, respectively, for PS and IR (p = .16). 43.8% of patients requiring reoperation did so on multiple occasions. Fifty PS and 41 IR cases had complete SRS 22 and ODI scores. Final SRS 22 total scores were 3.74 and 3.41 (p = .02) for the respective groups. ODI scores were 25.4% and 34.0% (p = .02).
  
  
  CONCLUSIONS
  Both groups had a significant number of revision surgeries performed by 5 years of follow-up. Unplanned reoperation significantly affected ODI and SRS 22 outcomes scores in the individual domains of pain, function, and overall satisfaction as well as total score at the 5-year follow-up regardless of PS or IR status. Overall, the PS group had improved outcomes when compared to the IR group.
authors.affiliation: Department of Orthopedics, St. Joseph's Regional Medical Center- Seton Hall University, Paterson, New Jersey, USA. Electronic address: michaelfaloonmd@gmail.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Faloon
authors.affiliation: Department of Orthopedics, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Essig
authors.affiliation: Department of Orthopedics, Albert Einstein College of Medicine-Montefiore University Hospital, New York, New York, USA.
authors.forename: Woojin
authors.initials: W
authors.lastname: Cho
authors.affiliation: Department of Orthopedics & Sports Medicine-St. Luke's University, Temple University Hospital, Easton, Pennsylvania, USA.
authors.forename: Gbolabo
authors.initials: G
authors.lastname: Sokunbi
authors.affiliation: Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery/Weill Cornell Medical College, New York, New York, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ross
authors.affiliation: Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery/Weill Cornell Medical College, New York, New York, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cunningham
authors.affiliation: Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery/Weill Cornell Medical College, New York, New York, USA.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Rawlins
authors.affiliation: Scoliosis Service, Department of Orthopaedic Surgery, Hospital for Special Surgery/Weill Cornell Medical College, New York, New York, USA.
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
keywords: Adult deformity; Complications; Outcomes; Revision surgery