The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery

Hamid Hassanzadeh, Joseph Gjolaj, Mostafa H. El Dafrawy, Amit Jain, Richard L. Skolasky, David B. Cohen, Khaled M. Kebaish

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background context: To our knowledge, the effect of the staging regimen on the surgical outcome in patients undergoing combined anterior/posterior surgery for the treatment of spinal deformity has not been previously studied. Purpose: To compare outcomes of anterior/posterior surgery for adult spinal deformity staged less than 21 days apart versus those 21 or more days apart. Study design: A retrospective comparison study. Patient sample: Patients aged 40 years or older who underwent combined anterior/posterior fusions for spinal deformities. Outcome measures: Self-reported measures, physiological measures, and functional measures. Methods: We retrospectively reviewed prospectively collected data for 63 consecutive patients (50 females and 13 males) older than 40 years who underwent combined anterior/posterior fusions for spinal deformities and who had a minimum of 2-year follow-up. We divided them into those who had surgery staged less than 21 days apart (Group 1, N=29) and those who had surgery staged 21 or more days apart (Group 2, N=34). The groups were not statistically different in age; preoperative American Society of Anesthesiologists, Scoliosis Research Society-22 (SRS-22) patient questionnaire, and Oswestry Disability Index (ODI) scores; number of previous surgeries; number of levels fused; or total operative time. Hotelling t square test and the chi-squared test were used to compare clinical and radiographic parameters, complications, and functional outcomes between groups (significance, p<.05). Results: Compared with Group 1 patients, Group 2 (staged) patients had a lower total estimated blood loss (average, 4.5 L [range, 1.90-8.75 L] vs. 4 L [range, 1.8-10.1 L], respectively), fewer combined hospital days (average, 14 days [range, 7-70 days] vs. 12 days [range, 6-44 days], respectively), and fewer major complications (total, 10 [35%] vs. 6 [18%], respectively). Preoperative SRS-22 and ODI scores were significantly better in Group 2 than in Group 1 at 6 weeks (p<.001) and at final follow-up (p<.001), respectively. Conclusion: For patients who require both anterior and posterior surgery for spinal deformity correction, staging the two procedures 21 or more days apart decreases total perioperative transfusion requirements although significantly improving functional outcomes.

Original languageEnglish (US)
Pages (from-to)1717-1722
Number of pages6
JournalSpine Journal
Volume13
Issue number12
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

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Spinal Fusion
Scoliosis
Chi-Square Distribution
Operative Time
Research
Retrospective Studies
Outcome Assessment (Health Care)
Therapeutics
Surveys and Questionnaires

Keywords

  • Adult spinal deformity
  • Complications
  • Outcome
  • Scoliosis
  • Two-stage anterior and posterior

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery. / Hassanzadeh, Hamid; Gjolaj, Joseph; El Dafrawy, Mostafa H.; Jain, Amit; Skolasky, Richard L.; Cohen, David B.; Kebaish, Khaled M.

In: Spine Journal, Vol. 13, No. 12, 01.12.2013, p. 1717-1722.

Research output: Contribution to journalArticle

Hassanzadeh, Hamid ; Gjolaj, Joseph ; El Dafrawy, Mostafa H. ; Jain, Amit ; Skolasky, Richard L. ; Cohen, David B. ; Kebaish, Khaled M. / The timing of surgical staging has a significant impact on the complications and functional outcomes of adult spinal deformity surgery. In: Spine Journal. 2013 ; Vol. 13, No. 12. pp. 1717-1722.
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AU - Jain, Amit

AU - Skolasky, Richard L.

AU - Cohen, David B.

AU - Kebaish, Khaled M.

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N2 - Background context: To our knowledge, the effect of the staging regimen on the surgical outcome in patients undergoing combined anterior/posterior surgery for the treatment of spinal deformity has not been previously studied. Purpose: To compare outcomes of anterior/posterior surgery for adult spinal deformity staged less than 21 days apart versus those 21 or more days apart. Study design: A retrospective comparison study. Patient sample: Patients aged 40 years or older who underwent combined anterior/posterior fusions for spinal deformities. Outcome measures: Self-reported measures, physiological measures, and functional measures. Methods: We retrospectively reviewed prospectively collected data for 63 consecutive patients (50 females and 13 males) older than 40 years who underwent combined anterior/posterior fusions for spinal deformities and who had a minimum of 2-year follow-up. We divided them into those who had surgery staged less than 21 days apart (Group 1, N=29) and those who had surgery staged 21 or more days apart (Group 2, N=34). The groups were not statistically different in age; preoperative American Society of Anesthesiologists, Scoliosis Research Society-22 (SRS-22) patient questionnaire, and Oswestry Disability Index (ODI) scores; number of previous surgeries; number of levels fused; or total operative time. Hotelling t square test and the chi-squared test were used to compare clinical and radiographic parameters, complications, and functional outcomes between groups (significance, p<.05). Results: Compared with Group 1 patients, Group 2 (staged) patients had a lower total estimated blood loss (average, 4.5 L [range, 1.90-8.75 L] vs. 4 L [range, 1.8-10.1 L], respectively), fewer combined hospital days (average, 14 days [range, 7-70 days] vs. 12 days [range, 6-44 days], respectively), and fewer major complications (total, 10 [35%] vs. 6 [18%], respectively). Preoperative SRS-22 and ODI scores were significantly better in Group 2 than in Group 1 at 6 weeks (p<.001) and at final follow-up (p<.001), respectively. Conclusion: For patients who require both anterior and posterior surgery for spinal deformity correction, staging the two procedures 21 or more days apart decreases total perioperative transfusion requirements although significantly improving functional outcomes.

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KW - Complications

KW - Outcome

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