Predictors of revision surgical procedure excluding wound complications in adult spinal deformity and impact on patient-reported outcomes and satisfaction

Peter G. Passias, Alexandra Soroceanu, Sun Yang, Frank Schwab, Christopher Ames, Anthony Boniello, Justin Smith, Christopher Shaffrey, Oheneba Boachie-Adjei, Gregory Mundis, Douglas Burton, Eric Klineberg, Robert Hart, D. Kojo Hamilton, Daniel Sciubba, Shay Bess, Virginie Lafage

Research output: Contribution to journalArticle

Abstract

Background: The surgical procedure to treat adult spinal deformity is challenging, with high rates of complications, including revision procedures performed to repair instrumentation failure or unplanned surgical complications. This study quantifies the incidence of, identifies predictors for, and determines health-related quality-of-life changes associated with revision procedures to treat adult spinal deformity. Methods: We analyzed a multicenter database of patients who underwent a surgical procedure for adult spinal deformity, which was defined as having an age of eighteen years or older and scoliosis of ≥20°, sagittal vertical axis of ≥5 cm, pelvic tilt of ≥25°, and/or thoracic kyphosis of >60°.We focused on demographic, radiographic, health-related quality-of-life, and operative data at the two-year follow-up. Patients with primary infections were excluded. Predictive and confounding variables for revisions were identified using univariate analysis and multivariate logistic regression modeling. Results: Two hundred and forty-three patients were included in this study; of these patients, forty (16.5%) underwent a revision surgical procedure (15% of these at six weeks, 38% between six weeks and one year, and 48% between one and two years). Screw or cage-related implant complications were the most common indications for revision, followed by proximal junctional kyphosis and rod failure. Positive predictors for a revision surgical procedure included total body mass, with an odds ratio of 1.33 (95% confidence interval, 1.04 to 1.70) per 10-kg increase, and preoperative sagittal vertical axis, with an odds ratio of 1.15 (95% confidence interval, 1.04 to 1.28) per 2-cm increase. Factors associated with lower risk of revision included use of bone morphogenetic protein-2 (BMP-2) (odds ratio, 0.16 [95% confidence interval, 0.05 to 0.47]) and greater diameter rods (odds ratio, 0.51 [95% confidence interval, 0.29 to 0.89]). Body mass index, although initially considered a potential predictor for a continued revision surgical procedure, was not significantly different between primary and revision cohorts on univariate analysis and was therefore not input into the multivariate model. All patients improved in two-year health-related quality-of-life scores; revision subjects had lower overall improvement (Scoliosis Research Society [SRS] score; p = 0.016) frombaseline. Revision status did not predict two-year patient satisfaction (p = 0.726), as measured by the SRS Satisfaction domain (SRS-22r). Conclusions: Patients with greater preoperative sagittal vertical axis and high total body mass are at a higher risk for a revision surgical procedure following procedures to treat adult spinal deformity. Larger diameter rods and BMP-2 were associated with decreased revision odds. Revisions did not impact patient satisfaction at two years.

Original languageEnglish (US)
Pages (from-to)536-543
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume98
Issue number7
DOIs
StatePublished - Apr 6 2016

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Reoperation
Wounds and Injuries
Scoliosis
Odds Ratio
Confidence Intervals
Bone Morphogenetic Protein 2
Kyphosis
Quality of Life
Patient Satisfaction
Research
Patient Reported Outcome Measures
Confounding Factors (Epidemiology)
Body Mass Index
Cohort Studies
Thorax
Multivariate Analysis
Logistic Models
Demography
Databases
Infection

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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Predictors of revision surgical procedure excluding wound complications in adult spinal deformity and impact on patient-reported outcomes and satisfaction. / Passias, Peter G.; Soroceanu, Alexandra; Yang, Sun; Schwab, Frank; Ames, Christopher; Boniello, Anthony; Smith, Justin; Shaffrey, Christopher; Boachie-Adjei, Oheneba; Mundis, Gregory; Burton, Douglas; Klineberg, Eric; Hart, Robert; Hamilton, D. Kojo; Sciubba, Daniel; Bess, Shay; Lafage, Virginie.

In: Journal of Bone and Joint Surgery - Series A, Vol. 98, No. 7, 06.04.2016, p. 536-543.

Research output: Contribution to journalArticle

Passias, PG, Soroceanu, A, Yang, S, Schwab, F, Ames, C, Boniello, A, Smith, J, Shaffrey, C, Boachie-Adjei, O, Mundis, G, Burton, D, Klineberg, E, Hart, R, Hamilton, DK, Sciubba, D, Bess, S & Lafage, V 2016, 'Predictors of revision surgical procedure excluding wound complications in adult spinal deformity and impact on patient-reported outcomes and satisfaction', Journal of Bone and Joint Surgery - Series A, vol. 98, no. 7, pp. 536-543. https://doi.org/10.2106/JBJS.14.01126
Passias, Peter G. ; Soroceanu, Alexandra ; Yang, Sun ; Schwab, Frank ; Ames, Christopher ; Boniello, Anthony ; Smith, Justin ; Shaffrey, Christopher ; Boachie-Adjei, Oheneba ; Mundis, Gregory ; Burton, Douglas ; Klineberg, Eric ; Hart, Robert ; Hamilton, D. Kojo ; Sciubba, Daniel ; Bess, Shay ; Lafage, Virginie. / Predictors of revision surgical procedure excluding wound complications in adult spinal deformity and impact on patient-reported outcomes and satisfaction. In: Journal of Bone and Joint Surgery - Series A. 2016 ; Vol. 98, No. 7. pp. 536-543.
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abstract = "Background: The surgical procedure to treat adult spinal deformity is challenging, with high rates of complications, including revision procedures performed to repair instrumentation failure or unplanned surgical complications. This study quantifies the incidence of, identifies predictors for, and determines health-related quality-of-life changes associated with revision procedures to treat adult spinal deformity. Methods: We analyzed a multicenter database of patients who underwent a surgical procedure for adult spinal deformity, which was defined as having an age of eighteen years or older and scoliosis of ≥20°, sagittal vertical axis of ≥5 cm, pelvic tilt of ≥25°, and/or thoracic kyphosis of >60°.We focused on demographic, radiographic, health-related quality-of-life, and operative data at the two-year follow-up. Patients with primary infections were excluded. Predictive and confounding variables for revisions were identified using univariate analysis and multivariate logistic regression modeling. Results: Two hundred and forty-three patients were included in this study; of these patients, forty (16.5{\%}) underwent a revision surgical procedure (15{\%} of these at six weeks, 38{\%} between six weeks and one year, and 48{\%} between one and two years). Screw or cage-related implant complications were the most common indications for revision, followed by proximal junctional kyphosis and rod failure. Positive predictors for a revision surgical procedure included total body mass, with an odds ratio of 1.33 (95{\%} confidence interval, 1.04 to 1.70) per 10-kg increase, and preoperative sagittal vertical axis, with an odds ratio of 1.15 (95{\%} confidence interval, 1.04 to 1.28) per 2-cm increase. Factors associated with lower risk of revision included use of bone morphogenetic protein-2 (BMP-2) (odds ratio, 0.16 [95{\%} confidence interval, 0.05 to 0.47]) and greater diameter rods (odds ratio, 0.51 [95{\%} confidence interval, 0.29 to 0.89]). Body mass index, although initially considered a potential predictor for a continued revision surgical procedure, was not significantly different between primary and revision cohorts on univariate analysis and was therefore not input into the multivariate model. All patients improved in two-year health-related quality-of-life scores; revision subjects had lower overall improvement (Scoliosis Research Society [SRS] score; p = 0.016) frombaseline. Revision status did not predict two-year patient satisfaction (p = 0.726), as measured by the SRS Satisfaction domain (SRS-22r). Conclusions: Patients with greater preoperative sagittal vertical axis and high total body mass are at a higher risk for a revision surgical procedure following procedures to treat adult spinal deformity. Larger diameter rods and BMP-2 were associated with decreased revision odds. Revisions did not impact patient satisfaction at two years.",
author = "Passias, {Peter G.} and Alexandra Soroceanu and Sun Yang and Frank Schwab and Christopher Ames and Anthony Boniello and Justin Smith and Christopher Shaffrey and Oheneba Boachie-Adjei and Gregory Mundis and Douglas Burton and Eric Klineberg and Robert Hart and Hamilton, {D. Kojo} and Daniel Sciubba and Shay Bess and Virginie Lafage",
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T1 - Predictors of revision surgical procedure excluding wound complications in adult spinal deformity and impact on patient-reported outcomes and satisfaction

AU - Passias, Peter G.

AU - Soroceanu, Alexandra

AU - Yang, Sun

AU - Schwab, Frank

AU - Ames, Christopher

AU - Boniello, Anthony

AU - Smith, Justin

AU - Shaffrey, Christopher

AU - Boachie-Adjei, Oheneba

AU - Mundis, Gregory

AU - Burton, Douglas

AU - Klineberg, Eric

AU - Hart, Robert

AU - Hamilton, D. Kojo

AU - Sciubba, Daniel

AU - Bess, Shay

AU - Lafage, Virginie

PY - 2016/4/6

Y1 - 2016/4/6

N2 - Background: The surgical procedure to treat adult spinal deformity is challenging, with high rates of complications, including revision procedures performed to repair instrumentation failure or unplanned surgical complications. This study quantifies the incidence of, identifies predictors for, and determines health-related quality-of-life changes associated with revision procedures to treat adult spinal deformity. Methods: We analyzed a multicenter database of patients who underwent a surgical procedure for adult spinal deformity, which was defined as having an age of eighteen years or older and scoliosis of ≥20°, sagittal vertical axis of ≥5 cm, pelvic tilt of ≥25°, and/or thoracic kyphosis of >60°.We focused on demographic, radiographic, health-related quality-of-life, and operative data at the two-year follow-up. Patients with primary infections were excluded. Predictive and confounding variables for revisions were identified using univariate analysis and multivariate logistic regression modeling. Results: Two hundred and forty-three patients were included in this study; of these patients, forty (16.5%) underwent a revision surgical procedure (15% of these at six weeks, 38% between six weeks and one year, and 48% between one and two years). Screw or cage-related implant complications were the most common indications for revision, followed by proximal junctional kyphosis and rod failure. Positive predictors for a revision surgical procedure included total body mass, with an odds ratio of 1.33 (95% confidence interval, 1.04 to 1.70) per 10-kg increase, and preoperative sagittal vertical axis, with an odds ratio of 1.15 (95% confidence interval, 1.04 to 1.28) per 2-cm increase. Factors associated with lower risk of revision included use of bone morphogenetic protein-2 (BMP-2) (odds ratio, 0.16 [95% confidence interval, 0.05 to 0.47]) and greater diameter rods (odds ratio, 0.51 [95% confidence interval, 0.29 to 0.89]). Body mass index, although initially considered a potential predictor for a continued revision surgical procedure, was not significantly different between primary and revision cohorts on univariate analysis and was therefore not input into the multivariate model. All patients improved in two-year health-related quality-of-life scores; revision subjects had lower overall improvement (Scoliosis Research Society [SRS] score; p = 0.016) frombaseline. Revision status did not predict two-year patient satisfaction (p = 0.726), as measured by the SRS Satisfaction domain (SRS-22r). Conclusions: Patients with greater preoperative sagittal vertical axis and high total body mass are at a higher risk for a revision surgical procedure following procedures to treat adult spinal deformity. Larger diameter rods and BMP-2 were associated with decreased revision odds. Revisions did not impact patient satisfaction at two years.

AB - Background: The surgical procedure to treat adult spinal deformity is challenging, with high rates of complications, including revision procedures performed to repair instrumentation failure or unplanned surgical complications. This study quantifies the incidence of, identifies predictors for, and determines health-related quality-of-life changes associated with revision procedures to treat adult spinal deformity. Methods: We analyzed a multicenter database of patients who underwent a surgical procedure for adult spinal deformity, which was defined as having an age of eighteen years or older and scoliosis of ≥20°, sagittal vertical axis of ≥5 cm, pelvic tilt of ≥25°, and/or thoracic kyphosis of >60°.We focused on demographic, radiographic, health-related quality-of-life, and operative data at the two-year follow-up. Patients with primary infections were excluded. Predictive and confounding variables for revisions were identified using univariate analysis and multivariate logistic regression modeling. Results: Two hundred and forty-three patients were included in this study; of these patients, forty (16.5%) underwent a revision surgical procedure (15% of these at six weeks, 38% between six weeks and one year, and 48% between one and two years). Screw or cage-related implant complications were the most common indications for revision, followed by proximal junctional kyphosis and rod failure. Positive predictors for a revision surgical procedure included total body mass, with an odds ratio of 1.33 (95% confidence interval, 1.04 to 1.70) per 10-kg increase, and preoperative sagittal vertical axis, with an odds ratio of 1.15 (95% confidence interval, 1.04 to 1.28) per 2-cm increase. Factors associated with lower risk of revision included use of bone morphogenetic protein-2 (BMP-2) (odds ratio, 0.16 [95% confidence interval, 0.05 to 0.47]) and greater diameter rods (odds ratio, 0.51 [95% confidence interval, 0.29 to 0.89]). Body mass index, although initially considered a potential predictor for a continued revision surgical procedure, was not significantly different between primary and revision cohorts on univariate analysis and was therefore not input into the multivariate model. All patients improved in two-year health-related quality-of-life scores; revision subjects had lower overall improvement (Scoliosis Research Society [SRS] score; p = 0.016) frombaseline. Revision status did not predict two-year patient satisfaction (p = 0.726), as measured by the SRS Satisfaction domain (SRS-22r). Conclusions: Patients with greater preoperative sagittal vertical axis and high total body mass are at a higher risk for a revision surgical procedure following procedures to treat adult spinal deformity. Larger diameter rods and BMP-2 were associated with decreased revision odds. Revisions did not impact patient satisfaction at two years.

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