title: A Comprehensive Review of Complication Rates After Surgery for Adult Deformity: A Reference for Informed Consent.
abstract: OBJECTIVE
  An up-to-date review of recent literatures and a comprehensive reference for informed consent specific to ASD complications is lacking. The goal of the present study was to determine current complication rates after ASD surgery, in order to provide a reference for informed consent as well as to determine differences between three-column and non-three-column osteotomy procedures to aid in shared decision making.
  
  
  METHODS
  A review of the literature was conducted using the PubMed database. Randomized controlled trials, nonrandomized trials, cohort studies, case-control studies, and case series providing postoperative complications published in 2000 or later were included. Complication rates were recorded and calculated for perioperative (both major and minor) and long-term complication rates. Postoperative outcomes were all stratified by surgical procedure (ie, three-column osteotomy and non-three-column osteotomy).
  
  
  RESULTS
  Ninety-three articles were ultimately eligible for analysis. The data of 11,692 patients were extracted; there were 3,646 complications, mean age at surgery was 53.3 years (range: 25-77 years), mean follow-up was 3.49 years (range: 6 weeks-9.7 years), estimated blood loss was 2,161 mL (range: 717-7,034 mL), and the overall mean complication rate was 55%. Specifically, major perioperative complications occurred at a mean rate of 18.5%, minor perioperative complications occurred at a mean rate of 15.7%, and long-term complications occurred at a mean rate of 20.5%. Furthermore, three-column osteotomy resulted in a higher overall complication rate and estimated blood loss than non-three-column osteotomy.
  
  
  CONCLUSIONS
  A review of recent literatures providing complication rates for ASD surgery was performed, providing the most up-to-date incidence of early and late complications. Providers may use such data in helping to counsel patients of the literature-supported complication rates of such procedures despite the planned benefits, thus obtaining a more thorough informed consent.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA. Electronic address: Dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA.
authors.forename: Alp
authors.initials: A
authors.lastname: Yurter
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Orthopedic Surgery, Washington University, 4921 Parkview Place, A 12, St. Louis, MO 63110, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, Oregon Health & Science University, 3182 SW Sam Jackson Park Rd; Ortho Dept MC: OP31, Portland, OR 97239, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.affiliation: Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University, 610 North Caroline Street, Suite 5243, Baltimore, MD 21287, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Kebaish
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M779 - Department of Neurosurgery, San Francisco, CA 94143, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
keywords: Adult spinal deformity; Complications; PSO; Scoliosis; Three-column osteotomy