Primary versus revision surgery in the setting of adult spinal deformity

A nationwide study on 10,912 patients

Bassel G. Diebo, Peter G. Passias, Bryan Marascalchi, Cyrus M. Jalai, Nancy J. Worley, Thomas J. Errico, Virginie Lafage

Research output: Contribution to journalArticle

Abstract

Study Design. Retrospective review of a prospectively collected database. Objective. This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary versus revision adult spinal deformity surgery Summary of Background Data. Although adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary versus revision spinal deformity surgery comparatively. Methods. Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity, and procedure-related complications incidence were determined for primary versus revision cohorts. Multivariate analysis reported as (OR [95% CI]). Results. Discharges for 9133 primary and 850 revision cases were identified. Patients differed on the basis of demographic and hospital data. Average comorbidity indices for the cohorts were similar (P=0.580), as was in-hospital mortality (P=0.163). The incidence of procedure-related complications was higher for the revision cohort (46.96 % vs. 71.97%, P=0.001). The mean hospital course for the revision cohort was longer (6.37 vs. 7.13 days, P<0.0001). Revisions had an increased risk of complications involving the nervous system (1.34[1.10-1.6]), hematoma/seroma formation (2.31[1.92-2.78]), accidental vessel or nerve puncture (1.44[1.29 - 1.61]), wound dehiscence (2.18[1.48-3.21]), postop infection (3.10[2.50-3.85]), and ARDS complications (1.43[1.28-1.60]). The primary cohort had a decreased risk for GI (0.65[0.55-0.76]) and GU complications (0.71[0.51-0.99]). Conclusion. Relative to primary cases, those undergoing revision correction of spinal deformity have a higher risk of many procedure-related complications with a longer hospital course despite similar baseline comorbidity burden and the in-hospital mortality rate. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality and direct future research to improve outcomes.

Original languageEnglish (US)
Pages (from-to)1674-1680
Number of pages7
JournalSpine
Volume40
Issue number21
DOIs
StatePublished - Oct 27 2015
Externally publishedYes

Fingerprint

Spinal Curvatures
Spinal Fusion
Reoperation
Comorbidity
Retrospective Studies
Demography
Morbidity
Mortality
Incidence
Hospital Mortality
Seroma
Scoliosis
Punctures
Hematoma
Nervous System
Inpatients
Thorax
Multivariate Analysis
Databases
Health

Keywords

  • ASD
  • Complications
  • Demographics
  • Morbidity
  • Mortality
  • Nationwide inpatient sample
  • Primary
  • Revision
  • Risk factors
  • Surgical management

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Diebo, B. G., Passias, P. G., Marascalchi, B., Jalai, C. M., Worley, N. J., Errico, T. J., & Lafage, V. (2015). Primary versus revision surgery in the setting of adult spinal deformity: A nationwide study on 10,912 patients. Spine, 40(21), 1674-1680. https://doi.org/10.1097/BRS.0000000000001114

Primary versus revision surgery in the setting of adult spinal deformity : A nationwide study on 10,912 patients. / Diebo, Bassel G.; Passias, Peter G.; Marascalchi, Bryan; Jalai, Cyrus M.; Worley, Nancy J.; Errico, Thomas J.; Lafage, Virginie.

In: Spine, Vol. 40, No. 21, 27.10.2015, p. 1674-1680.

Research output: Contribution to journalArticle

Diebo, Bassel G. ; Passias, Peter G. ; Marascalchi, Bryan ; Jalai, Cyrus M. ; Worley, Nancy J. ; Errico, Thomas J. ; Lafage, Virginie. / Primary versus revision surgery in the setting of adult spinal deformity : A nationwide study on 10,912 patients. In: Spine. 2015 ; Vol. 40, No. 21. pp. 1674-1680.
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abstract = "Study Design. Retrospective review of a prospectively collected database. Objective. This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary versus revision adult spinal deformity surgery Summary of Background Data. Although adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary versus revision spinal deformity surgery comparatively. Methods. Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity, and procedure-related complications incidence were determined for primary versus revision cohorts. Multivariate analysis reported as (OR [95{\%} CI]). Results. Discharges for 9133 primary and 850 revision cases were identified. Patients differed on the basis of demographic and hospital data. Average comorbidity indices for the cohorts were similar (P=0.580), as was in-hospital mortality (P=0.163). The incidence of procedure-related complications was higher for the revision cohort (46.96 {\%} vs. 71.97{\%}, P=0.001). The mean hospital course for the revision cohort was longer (6.37 vs. 7.13 days, P<0.0001). Revisions had an increased risk of complications involving the nervous system (1.34[1.10-1.6]), hematoma/seroma formation (2.31[1.92-2.78]), accidental vessel or nerve puncture (1.44[1.29 - 1.61]), wound dehiscence (2.18[1.48-3.21]), postop infection (3.10[2.50-3.85]), and ARDS complications (1.43[1.28-1.60]). The primary cohort had a decreased risk for GI (0.65[0.55-0.76]) and GU complications (0.71[0.51-0.99]). Conclusion. Relative to primary cases, those undergoing revision correction of spinal deformity have a higher risk of many procedure-related complications with a longer hospital course despite similar baseline comorbidity burden and the in-hospital mortality rate. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality and direct future research to improve outcomes.",
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T1 - Primary versus revision surgery in the setting of adult spinal deformity

T2 - A nationwide study on 10,912 patients

AU - Diebo, Bassel G.

AU - Passias, Peter G.

AU - Marascalchi, Bryan

AU - Jalai, Cyrus M.

AU - Worley, Nancy J.

AU - Errico, Thomas J.

AU - Lafage, Virginie

PY - 2015/10/27

Y1 - 2015/10/27

N2 - Study Design. Retrospective review of a prospectively collected database. Objective. This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary versus revision adult spinal deformity surgery Summary of Background Data. Although adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary versus revision spinal deformity surgery comparatively. Methods. Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity, and procedure-related complications incidence were determined for primary versus revision cohorts. Multivariate analysis reported as (OR [95% CI]). Results. Discharges for 9133 primary and 850 revision cases were identified. Patients differed on the basis of demographic and hospital data. Average comorbidity indices for the cohorts were similar (P=0.580), as was in-hospital mortality (P=0.163). The incidence of procedure-related complications was higher for the revision cohort (46.96 % vs. 71.97%, P=0.001). The mean hospital course for the revision cohort was longer (6.37 vs. 7.13 days, P<0.0001). Revisions had an increased risk of complications involving the nervous system (1.34[1.10-1.6]), hematoma/seroma formation (2.31[1.92-2.78]), accidental vessel or nerve puncture (1.44[1.29 - 1.61]), wound dehiscence (2.18[1.48-3.21]), postop infection (3.10[2.50-3.85]), and ARDS complications (1.43[1.28-1.60]). The primary cohort had a decreased risk for GI (0.65[0.55-0.76]) and GU complications (0.71[0.51-0.99]). Conclusion. Relative to primary cases, those undergoing revision correction of spinal deformity have a higher risk of many procedure-related complications with a longer hospital course despite similar baseline comorbidity burden and the in-hospital mortality rate. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality and direct future research to improve outcomes.

AB - Study Design. Retrospective review of a prospectively collected database. Objective. This study compares patient demographics, incidence of comorbidities, procedure-related complications, and mortality following primary versus revision adult spinal deformity surgery Summary of Background Data. Although adult spinal deformity (ASD) surgery has been extensively investigated, no previous study has provided nationwide estimates of patient characteristics and procedure-related complications for primary versus revision spinal deformity surgery comparatively. Methods. Nationwide Inpatient Sample data collected between 2001 and 2010 was analyzed. Discharges with procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included for patients aged 25+ and 4+ levels fused with any diagnoses specific for scoliosis. Patient demographics, comorbidity, and procedure-related complications incidence were determined for primary versus revision cohorts. Multivariate analysis reported as (OR [95% CI]). Results. Discharges for 9133 primary and 850 revision cases were identified. Patients differed on the basis of demographic and hospital data. Average comorbidity indices for the cohorts were similar (P=0.580), as was in-hospital mortality (P=0.163). The incidence of procedure-related complications was higher for the revision cohort (46.96 % vs. 71.97%, P=0.001). The mean hospital course for the revision cohort was longer (6.37 vs. 7.13 days, P<0.0001). Revisions had an increased risk of complications involving the nervous system (1.34[1.10-1.6]), hematoma/seroma formation (2.31[1.92-2.78]), accidental vessel or nerve puncture (1.44[1.29 - 1.61]), wound dehiscence (2.18[1.48-3.21]), postop infection (3.10[2.50-3.85]), and ARDS complications (1.43[1.28-1.60]). The primary cohort had a decreased risk for GI (0.65[0.55-0.76]) and GU complications (0.71[0.51-0.99]). Conclusion. Relative to primary cases, those undergoing revision correction of spinal deformity have a higher risk of many procedure-related complications with a longer hospital course despite similar baseline comorbidity burden and the in-hospital mortality rate. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality and direct future research to improve outcomes.

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KW - Complications

KW - Demographics

KW - Morbidity

KW - Mortality

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KW - Primary

KW - Revision

KW - Risk factors

KW - Surgical management

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