Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database

Justin K. Scheer, Jessica A. Tang, Justin S. Smith, Eric Klineberg, Robert Hart, Gregory M. Mundis, Douglas C. Burton, Richard Hostin, Michael F. O'Brien, Shay Bess, Khaled M. Kebaish, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Object. Complications and reoperation for surgery to correct adult spinal deformity are not infrequent, and many studies have analyzed the rates and factors that influence the likelihood of reoperation. However, there is a need for more comprehensive analyses of reoperation in adult spinal deformity surgery from a global standpoint, particularly focusing on the 1st year following operation and considering radiographic parameters and the effects of reoperation on health-related quality of life (HRQOL). This study attempts to determine the prevalence of reoperation following surgery for adult spinal deformity, assess the indications for these reoperations, evaluate for a relation between specific radiographic parameters and the need for reoperation, and determine the potential impact of reoperation on HRQOL measures. Methods. A retrospective review was conducted of a prospective, multicenter, adult spinal deformity database collected through the International Spine Study Group. Data collected included age, body mass index, sex, date of surgery, information regarding complications, reoperation dates, length of stay, and operation time. The radiographic parameters assessed were total number of levels instrumented, total number of interbody fusions, C-7 sagittal vertical axis, uppermost instrumented vertebra (UIV) location, and presence of 3-column osteotomies. The HRQOL assessment included Oswestry Disability Index (ODI), 36-Item Short Form Health Survey physical component and mental component summary, and SRS-22 scores. Smoking history, Charlson Comorbidity Index scores, and American Society of Anesthesiologists Physical Status classification grades were also collected and assessed for correlation with risk of early reoperation. Various statistical tests were performed for evaluation of specific factors listed above, and the level of significance was set at p <0.05. Results. Fifty-nine (17%) of a total of 352 patients required reoperation. Forty-four (12.5%) of the reoperations occurred within 1 year after the initial surgery, including 17 reoperations (5%) within 30 days. Two hundred sixty-eight patients had a minimum of 1 year of follow-up. Fifty-three (20%) of these patients had a 3-column osteotomy, and 10 (19%) of these 53 required reoperation within 1 year of the initial procedure. However, 3-column osteotomy was not predictive of reoperation within 1 year, p = 0.5476). There were no significant differences between groups with regard to the distribution of UIV, and UIV did not have a significant effect on reoperation rates. Patients needing reoperation within 1 year had worse ODI and SRS-22 scores measured at 1-year follow-up than patients not requiring operation. Conclusions. Analysis of data from a large multicenter adult spinal deformity database shows an overall 17% reoperation rate, with a 19% reoperation rate for patients treated with 3-column osteotomy and a 16% reoperation rate for patients not treated with 3-column osteotomy. The most common indications for reoperation included instrumentation complications and radiographic failure. Reoperation significantly affected HRQOL outcomes at 1-year follow-up. The need for reoperation may be minimized by carefully considering spinal alignment, termination of fixation, and type of surgical procedure (presence of osteotomy). Precautions should be taken to avoid malposition or instrumentation (rod) failure.

Original languageEnglish (US)
Pages (from-to)464-470
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume19
Issue number4
DOIs
StatePublished - Oct 2013

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Reoperation
Databases
Osteotomy
Spine
Quality of Life

Keywords

  • HRQOL
  • Quality of life
  • Reoperation
  • Spinal deformity

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Scheer, J. K., Tang, J. A., Smith, J. S., Klineberg, E., Hart, R., Mundis, G. M., ... Ames, C. P. (2013). Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database. Journal of Neurosurgery: Spine, 19(4), 464-470. https://doi.org/10.3171/2013.7.SPINE12901

Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database. / Scheer, Justin K.; Tang, Jessica A.; Smith, Justin S.; Klineberg, Eric; Hart, Robert; Mundis, Gregory M.; Burton, Douglas C.; Hostin, Richard; O'Brien, Michael F.; Bess, Shay; Kebaish, Khaled M.; Deviren, Vedat; Lafage, Virginie; Schwab, Frank; Shaffrey, Christopher I.; Ames, Christopher P.

In: Journal of Neurosurgery: Spine, Vol. 19, No. 4, 10.2013, p. 464-470.

Research output: Contribution to journalArticle

Scheer, JK, Tang, JA, Smith, JS, Klineberg, E, Hart, R, Mundis, GM, Burton, DC, Hostin, R, O'Brien, MF, Bess, S, Kebaish, KM, Deviren, V, Lafage, V, Schwab, F, Shaffrey, CI & Ames, CP 2013, 'Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database', Journal of Neurosurgery: Spine, vol. 19, no. 4, pp. 464-470. https://doi.org/10.3171/2013.7.SPINE12901
Scheer, Justin K. ; Tang, Jessica A. ; Smith, Justin S. ; Klineberg, Eric ; Hart, Robert ; Mundis, Gregory M. ; Burton, Douglas C. ; Hostin, Richard ; O'Brien, Michael F. ; Bess, Shay ; Kebaish, Khaled M. ; Deviren, Vedat ; Lafage, Virginie ; Schwab, Frank ; Shaffrey, Christopher I. ; Ames, Christopher P. / Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database. In: Journal of Neurosurgery: Spine. 2013 ; Vol. 19, No. 4. pp. 464-470.
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abstract = "Object. Complications and reoperation for surgery to correct adult spinal deformity are not infrequent, and many studies have analyzed the rates and factors that influence the likelihood of reoperation. However, there is a need for more comprehensive analyses of reoperation in adult spinal deformity surgery from a global standpoint, particularly focusing on the 1st year following operation and considering radiographic parameters and the effects of reoperation on health-related quality of life (HRQOL). This study attempts to determine the prevalence of reoperation following surgery for adult spinal deformity, assess the indications for these reoperations, evaluate for a relation between specific radiographic parameters and the need for reoperation, and determine the potential impact of reoperation on HRQOL measures. Methods. A retrospective review was conducted of a prospective, multicenter, adult spinal deformity database collected through the International Spine Study Group. Data collected included age, body mass index, sex, date of surgery, information regarding complications, reoperation dates, length of stay, and operation time. The radiographic parameters assessed were total number of levels instrumented, total number of interbody fusions, C-7 sagittal vertical axis, uppermost instrumented vertebra (UIV) location, and presence of 3-column osteotomies. The HRQOL assessment included Oswestry Disability Index (ODI), 36-Item Short Form Health Survey physical component and mental component summary, and SRS-22 scores. Smoking history, Charlson Comorbidity Index scores, and American Society of Anesthesiologists Physical Status classification grades were also collected and assessed for correlation with risk of early reoperation. Various statistical tests were performed for evaluation of specific factors listed above, and the level of significance was set at p <0.05. Results. Fifty-nine (17{\%}) of a total of 352 patients required reoperation. Forty-four (12.5{\%}) of the reoperations occurred within 1 year after the initial surgery, including 17 reoperations (5{\%}) within 30 days. Two hundred sixty-eight patients had a minimum of 1 year of follow-up. Fifty-three (20{\%}) of these patients had a 3-column osteotomy, and 10 (19{\%}) of these 53 required reoperation within 1 year of the initial procedure. However, 3-column osteotomy was not predictive of reoperation within 1 year, p = 0.5476). There were no significant differences between groups with regard to the distribution of UIV, and UIV did not have a significant effect on reoperation rates. Patients needing reoperation within 1 year had worse ODI and SRS-22 scores measured at 1-year follow-up than patients not requiring operation. Conclusions. Analysis of data from a large multicenter adult spinal deformity database shows an overall 17{\%} reoperation rate, with a 19{\%} reoperation rate for patients treated with 3-column osteotomy and a 16{\%} reoperation rate for patients not treated with 3-column osteotomy. The most common indications for reoperation included instrumentation complications and radiographic failure. Reoperation significantly affected HRQOL outcomes at 1-year follow-up. The need for reoperation may be minimized by carefully considering spinal alignment, termination of fixation, and type of surgical procedure (presence of osteotomy). Precautions should be taken to avoid malposition or instrumentation (rod) failure.",
keywords = "HRQOL, Quality of life, Reoperation, Spinal deformity",
author = "Scheer, {Justin K.} and Tang, {Jessica A.} and Smith, {Justin S.} and Eric Klineberg and Robert Hart and Mundis, {Gregory M.} and Burton, {Douglas C.} and Richard Hostin and O'Brien, {Michael F.} and Shay Bess and Kebaish, {Khaled M.} and Vedat Deviren and Virginie Lafage and Frank Schwab and Shaffrey, {Christopher I.} and Ames, {Christopher P.}",
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language = "English (US)",
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TY - JOUR

T1 - Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database

AU - Scheer, Justin K.

AU - Tang, Jessica A.

AU - Smith, Justin S.

AU - Klineberg, Eric

AU - Hart, Robert

AU - Mundis, Gregory M.

AU - Burton, Douglas C.

AU - Hostin, Richard

AU - O'Brien, Michael F.

AU - Bess, Shay

AU - Kebaish, Khaled M.

AU - Deviren, Vedat

AU - Lafage, Virginie

AU - Schwab, Frank

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

PY - 2013/10

Y1 - 2013/10

N2 - Object. Complications and reoperation for surgery to correct adult spinal deformity are not infrequent, and many studies have analyzed the rates and factors that influence the likelihood of reoperation. However, there is a need for more comprehensive analyses of reoperation in adult spinal deformity surgery from a global standpoint, particularly focusing on the 1st year following operation and considering radiographic parameters and the effects of reoperation on health-related quality of life (HRQOL). This study attempts to determine the prevalence of reoperation following surgery for adult spinal deformity, assess the indications for these reoperations, evaluate for a relation between specific radiographic parameters and the need for reoperation, and determine the potential impact of reoperation on HRQOL measures. Methods. A retrospective review was conducted of a prospective, multicenter, adult spinal deformity database collected through the International Spine Study Group. Data collected included age, body mass index, sex, date of surgery, information regarding complications, reoperation dates, length of stay, and operation time. The radiographic parameters assessed were total number of levels instrumented, total number of interbody fusions, C-7 sagittal vertical axis, uppermost instrumented vertebra (UIV) location, and presence of 3-column osteotomies. The HRQOL assessment included Oswestry Disability Index (ODI), 36-Item Short Form Health Survey physical component and mental component summary, and SRS-22 scores. Smoking history, Charlson Comorbidity Index scores, and American Society of Anesthesiologists Physical Status classification grades were also collected and assessed for correlation with risk of early reoperation. Various statistical tests were performed for evaluation of specific factors listed above, and the level of significance was set at p <0.05. Results. Fifty-nine (17%) of a total of 352 patients required reoperation. Forty-four (12.5%) of the reoperations occurred within 1 year after the initial surgery, including 17 reoperations (5%) within 30 days. Two hundred sixty-eight patients had a minimum of 1 year of follow-up. Fifty-three (20%) of these patients had a 3-column osteotomy, and 10 (19%) of these 53 required reoperation within 1 year of the initial procedure. However, 3-column osteotomy was not predictive of reoperation within 1 year, p = 0.5476). There were no significant differences between groups with regard to the distribution of UIV, and UIV did not have a significant effect on reoperation rates. Patients needing reoperation within 1 year had worse ODI and SRS-22 scores measured at 1-year follow-up than patients not requiring operation. Conclusions. Analysis of data from a large multicenter adult spinal deformity database shows an overall 17% reoperation rate, with a 19% reoperation rate for patients treated with 3-column osteotomy and a 16% reoperation rate for patients not treated with 3-column osteotomy. The most common indications for reoperation included instrumentation complications and radiographic failure. Reoperation significantly affected HRQOL outcomes at 1-year follow-up. The need for reoperation may be minimized by carefully considering spinal alignment, termination of fixation, and type of surgical procedure (presence of osteotomy). Precautions should be taken to avoid malposition or instrumentation (rod) failure.

AB - Object. Complications and reoperation for surgery to correct adult spinal deformity are not infrequent, and many studies have analyzed the rates and factors that influence the likelihood of reoperation. However, there is a need for more comprehensive analyses of reoperation in adult spinal deformity surgery from a global standpoint, particularly focusing on the 1st year following operation and considering radiographic parameters and the effects of reoperation on health-related quality of life (HRQOL). This study attempts to determine the prevalence of reoperation following surgery for adult spinal deformity, assess the indications for these reoperations, evaluate for a relation between specific radiographic parameters and the need for reoperation, and determine the potential impact of reoperation on HRQOL measures. Methods. A retrospective review was conducted of a prospective, multicenter, adult spinal deformity database collected through the International Spine Study Group. Data collected included age, body mass index, sex, date of surgery, information regarding complications, reoperation dates, length of stay, and operation time. The radiographic parameters assessed were total number of levels instrumented, total number of interbody fusions, C-7 sagittal vertical axis, uppermost instrumented vertebra (UIV) location, and presence of 3-column osteotomies. The HRQOL assessment included Oswestry Disability Index (ODI), 36-Item Short Form Health Survey physical component and mental component summary, and SRS-22 scores. Smoking history, Charlson Comorbidity Index scores, and American Society of Anesthesiologists Physical Status classification grades were also collected and assessed for correlation with risk of early reoperation. Various statistical tests were performed for evaluation of specific factors listed above, and the level of significance was set at p <0.05. Results. Fifty-nine (17%) of a total of 352 patients required reoperation. Forty-four (12.5%) of the reoperations occurred within 1 year after the initial surgery, including 17 reoperations (5%) within 30 days. Two hundred sixty-eight patients had a minimum of 1 year of follow-up. Fifty-three (20%) of these patients had a 3-column osteotomy, and 10 (19%) of these 53 required reoperation within 1 year of the initial procedure. However, 3-column osteotomy was not predictive of reoperation within 1 year, p = 0.5476). There were no significant differences between groups with regard to the distribution of UIV, and UIV did not have a significant effect on reoperation rates. Patients needing reoperation within 1 year had worse ODI and SRS-22 scores measured at 1-year follow-up than patients not requiring operation. Conclusions. Analysis of data from a large multicenter adult spinal deformity database shows an overall 17% reoperation rate, with a 19% reoperation rate for patients treated with 3-column osteotomy and a 16% reoperation rate for patients not treated with 3-column osteotomy. The most common indications for reoperation included instrumentation complications and radiographic failure. Reoperation significantly affected HRQOL outcomes at 1-year follow-up. The need for reoperation may be minimized by carefully considering spinal alignment, termination of fixation, and type of surgical procedure (presence of osteotomy). Precautions should be taken to avoid malposition or instrumentation (rod) failure.

KW - HRQOL

KW - Quality of life

KW - Reoperation

KW - Spinal deformity

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