title: Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis.
abstract: Longitudinal cohort.
  
  
  
  To identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity.
  
  
  
  Increasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient's health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity.
  
  
  
  The data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events.
  
  
  
  Of 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071).
  
  
  
  Factors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient's quality of life.
  
  
  
  Level II. Prospective cohort.
authors.affiliation: Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
authors.affiliation: Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.affiliation: Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. Suite 4WW-449, Toronto, ON M5T2S8, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark.
authors.forename: Benny
authors.initials: B
authors.lastname: Dahl
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, 400 Parnassus Ave, San Francisco, CA 94143.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu-city, Shizuoka 431-3192, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.affiliation: Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Centre for Spinal Studies and Surgery, Queen's Medical Centre, Derby Rd, Nottingham NG7 2UH, United Kingdom.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mehdian
authors.affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China.
authors.forename: Kenneth M C
authors.initials: KM
authors.lastname: Cheung
authors.affiliation: Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10021, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.affiliation: Spine Surgery Unit, Hospital Vall d'Hebron, Traumatology Building 2nd Floor, Passeig Vall Hebron 119-129, Barcelona 08035, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellisé
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.affiliation: The Spine Hospital, Columbia University Medical Center, 5141 Broadway, 3 Field West, New York, NY 10034, USA.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods / Q000523:psychology*; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology*; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012600:Scoliosis / Q000523:psychology* / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adult spinal deformity; Clinical outcomes; Complication; HRQOL; Health-related quality of life; Osteotomies; Predictor; Scoli-Risk-1; Scoliosis Research-22R; Short Form 36