After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries with 2-Year Follow-up

Bassel G. Diebo, Virginie Lafage, Jeffrey J. Varghese, Munish Gupta, Han Jo Kim, Christopher Ames, Khaled Kebaish, Christopher Shaffrey, Richard Hostin, Ibrahim Obeid, Doug Burton, Robert Hart, Renaud Lafage, Frank J. Schwab

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies refects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO. OBJECTIVE: To investigate if performance of 3CO surgeries improves with years of practice. METHODS: Patientswho underwent 3CO for spinal deformitywith intra/postoperative and revision data collected up to 2 yr were included. Patients were chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t-test. Postoperative and revision rates were compared using Chi-square analysis. RESULTS: Five hundred seventy-three patients were stratifed into: G1 (n = 143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4 = 49.2 vs G1 = 38.3, P =.001), and received a larger osteotomy resection (G4 = 26 vs G1 = 20, P =.011) than the earliest group. There was a decrease in revision rate (45%, 35%, 33%, 30%, P =.039), notably in revisions for pseudarthrosis (16.7% G1 vs 6.9% G4, P =.007). Major complication rates also decreased (57%, 50%, 46%, 39%, P =.023) as did excessive blood loss (>4 L, 27.2 vs 16.7%, P =.023) and bladder/bowel defcit (4.2% vs 0.7% P =.002). Successful outcomes (no complications or revision) signifcantly increased (P =.001). CONCLUSION: Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalClinical Neurosurgery
Volume83
Issue number1
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

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Osteotomy
Pseudarthrosis
Urinary Bladder
Spine
Demography
Students
Population
Therapeutics

Keywords

  • Complication rate
  • Revision rate
  • Spinal deformity
  • Spinal osteotomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries with 2-Year Follow-up. / Diebo, Bassel G.; Lafage, Virginie; Varghese, Jeffrey J.; Gupta, Munish; Kim, Han Jo; Ames, Christopher; Kebaish, Khaled; Shaffrey, Christopher; Hostin, Richard; Obeid, Ibrahim; Burton, Doug; Hart, Robert; Lafage, Renaud; Schwab, Frank J.

In: Clinical Neurosurgery, Vol. 83, No. 1, 01.07.2018, p. 69-75.

Research output: Contribution to journalArticle

Diebo, BG, Lafage, V, Varghese, JJ, Gupta, M, Kim, HJ, Ames, C, Kebaish, K, Shaffrey, C, Hostin, R, Obeid, I, Burton, D, Hart, R, Lafage, R & Schwab, FJ 2018, 'After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries with 2-Year Follow-up', Clinical Neurosurgery, vol. 83, no. 1, pp. 69-75. https://doi.org/10.1093/neuros/nyx338
Diebo, Bassel G. ; Lafage, Virginie ; Varghese, Jeffrey J. ; Gupta, Munish ; Kim, Han Jo ; Ames, Christopher ; Kebaish, Khaled ; Shaffrey, Christopher ; Hostin, Richard ; Obeid, Ibrahim ; Burton, Doug ; Hart, Robert ; Lafage, Renaud ; Schwab, Frank J. / After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries with 2-Year Follow-up. In: Clinical Neurosurgery. 2018 ; Vol. 83, No. 1. pp. 69-75.
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abstract = "BACKGROUND: In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies refects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO. OBJECTIVE: To investigate if performance of 3CO surgeries improves with years of practice. METHODS: Patientswho underwent 3CO for spinal deformitywith intra/postoperative and revision data collected up to 2 yr were included. Patients were chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t-test. Postoperative and revision rates were compared using Chi-square analysis. RESULTS: Five hundred seventy-three patients were stratifed into: G1 (n = 143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4 = 49.2 vs G1 = 38.3, P =.001), and received a larger osteotomy resection (G4 = 26 vs G1 = 20, P =.011) than the earliest group. There was a decrease in revision rate (45{\%}, 35{\%}, 33{\%}, 30{\%}, P =.039), notably in revisions for pseudarthrosis (16.7{\%} G1 vs 6.9{\%} G4, P =.007). Major complication rates also decreased (57{\%}, 50{\%}, 46{\%}, 39{\%}, P =.023) as did excessive blood loss (>4 L, 27.2 vs 16.7{\%}, P =.023) and bladder/bowel defcit (4.2{\%} vs 0.7{\%} P =.002). Successful outcomes (no complications or revision) signifcantly increased (P =.001). CONCLUSION: Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.",
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T1 - After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries with 2-Year Follow-up

AU - Diebo, Bassel G.

AU - Lafage, Virginie

AU - Varghese, Jeffrey J.

AU - Gupta, Munish

AU - Kim, Han Jo

AU - Ames, Christopher

AU - Kebaish, Khaled

AU - Shaffrey, Christopher

AU - Hostin, Richard

AU - Obeid, Ibrahim

AU - Burton, Doug

AU - Hart, Robert

AU - Lafage, Renaud

AU - Schwab, Frank J.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - BACKGROUND: In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies refects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO. OBJECTIVE: To investigate if performance of 3CO surgeries improves with years of practice. METHODS: Patientswho underwent 3CO for spinal deformitywith intra/postoperative and revision data collected up to 2 yr were included. Patients were chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t-test. Postoperative and revision rates were compared using Chi-square analysis. RESULTS: Five hundred seventy-three patients were stratifed into: G1 (n = 143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4 = 49.2 vs G1 = 38.3, P =.001), and received a larger osteotomy resection (G4 = 26 vs G1 = 20, P =.011) than the earliest group. There was a decrease in revision rate (45%, 35%, 33%, 30%, P =.039), notably in revisions for pseudarthrosis (16.7% G1 vs 6.9% G4, P =.007). Major complication rates also decreased (57%, 50%, 46%, 39%, P =.023) as did excessive blood loss (>4 L, 27.2 vs 16.7%, P =.023) and bladder/bowel defcit (4.2% vs 0.7% P =.002). Successful outcomes (no complications or revision) signifcantly increased (P =.001). CONCLUSION: Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.

AB - BACKGROUND: In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies refects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO. OBJECTIVE: To investigate if performance of 3CO surgeries improves with years of practice. METHODS: Patientswho underwent 3CO for spinal deformitywith intra/postoperative and revision data collected up to 2 yr were included. Patients were chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t-test. Postoperative and revision rates were compared using Chi-square analysis. RESULTS: Five hundred seventy-three patients were stratifed into: G1 (n = 143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4 = 49.2 vs G1 = 38.3, P =.001), and received a larger osteotomy resection (G4 = 26 vs G1 = 20, P =.011) than the earliest group. There was a decrease in revision rate (45%, 35%, 33%, 30%, P =.039), notably in revisions for pseudarthrosis (16.7% G1 vs 6.9% G4, P =.007). Major complication rates also decreased (57%, 50%, 46%, 39%, P =.023) as did excessive blood loss (>4 L, 27.2 vs 16.7%, P =.023) and bladder/bowel defcit (4.2% vs 0.7% P =.002). Successful outcomes (no complications or revision) signifcantly increased (P =.001). CONCLUSION: Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.

KW - Complication rate

KW - Revision rate

KW - Spinal deformity

KW - Spinal osteotomy

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