Surgical Factors and Treatment Severity for Perioperative Complications Predict Hospital Length of Stay in Adult Spinal Deformity Surgery

Abstract

International Spine Study GroupStudy Design. Retrospective review of prospectively collected multicenter registry data.Objective. The aim of this study was to determine whether surgical variables and complications as graded by treatment severity impact postoperative hospital length of stay (LOS). Summary of Background Data. Surgical treatment can substantially improve quality of life for patients with adult spinal deformity (ASD). However, surgical treatment is associated with high complication rates, which may impact hospital LOS. Classifying complications by severity of subsequent treatment may allow surgeons to better understand complications and predict their impact on important outcome metrics, including LOS. Methods. Patients enrolled in a multicenter, prospectively enrolled database for ASD were assessed for study inclusion. Complications were graded based on intervention severity.Associations between LOS, complication intervention severity, and surgical variables (fusion length, use of interbody fusion, use of major osteotomy, primary versus revision surgery, same day vs. staged surgery, and surgical approach), were assessed. Two multivariate regression models were constructed to assess for independent associations with LOS. Results. Of 1183 patients meeting inclusion criteria, 708 did not and 475 did experience a perioperative complication during their index hospitalization, with 660 and 436 included in the final cohorts, respectively. Among those with complications, intervention severities included 14.9% with no intervention, 68.6% with minor, 8.9% with moderate, and 7.6% with severe interventions. Multivariate regression modeling demonstrated that length of posterior fusion, use of major osteotomy, staged surgery, and severity of intervention for complications were significantly associated with LOS. Conclusion. Careful selection of surgical factors may help reduce hospital LOS following surgery for ASD. Classification of complications by treatment severity can help surgeons better understand and predict the implications of complications, in turn assisting with surgical planning and patient counseling.

Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

“…In theory, staging should result in less blood loss and fluid administration, but its impact on perioperative outcomes including ischemic optic neuropathy still has not been well described. 131…”

The Differences Between Same-Day and Staged (Circumferential) Fusion Surgery in Adult Spinal Deformity: Protocol for a Systematic Review

“…Depending on the complexity and patient-specific surgical risk profile, ASD surgeries, such as circumferential procedures, can be done on the same day or staged and completed on a different date [10][11][12][13][14][15][16][17]. Differences in outcome between same-day and staged surgery have been a topic of interest for surgeons.…”

An Economic Analysis of Early and Late Complications After Adult Spinal Deformity Correction

“… 3 , 4 Moreover, this risk is compounded by the severity of baseline deformity present and the degree of surgical intervention necessary to correct such deformity. 5 , 6 Complication rates following corrective surgery for ASD can be extensive, with some studies reporting rates as high as 71%. Nonetheless, the nature of these complications vary with respect to their incidence and cost-utility.…”