Benchmark Values for Construct Survival and Complications by Type of ASD Surgery.

Autor:	Bass RD; Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY., Lafage R; Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY., Smith JS; Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA., Ames C; Department of Neurosurgery, University of California School of Medicine, San Francisco, CA., Bess S; Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO., Eastlack R; Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA., Gupta M; Department of Orthopedic Surgery, Washington University, St Louis, MO., Hostin R; Southwest Scoliosis and Spine Institute, Dallas, TX., Kebaish K; Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD., Kim HJ; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY., Klineberg E; Department of Orthopedic Surgery, UTHealth, Hoston, TX., Mundis G; Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA., Okonkwo D; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA., Shaffrey C; Department of Neurosurgery, Duke University Medical Center, Durham, NC., Schwab F; Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY., Lafage V; Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY., Burton D; Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2024 Sep 15; Vol. 49 (18), pp. 1259-1268. Date of Electronic Publication: 2024 Apr 15.
DOI:	10.1097/BRS.0000000000005012
Abstrakt:	Objective: The aim of this study was to provide benchmarks for the rates of complications by type of surgery performed. Study Design: Prospective multicenter database. Background: We have previously examined overall construct survival and complication rates for ASD surgery. However, the relationship between type of surgery and construct survival warrants more detailed assessment. Materials and Methods: Eight surgical scenarios were defined based on the levels treated, previous fusion status [primary (P) vs. revision (R)], and three-column osteotomy use (3CO): short lumbar fusion, LT-pelvis with 5 to 12 levels treated (P, R, or 3CO), UT-pelvis with 13 levels treated (P, R, or 3CO), and thoracic to lumbar fusion without pelvic fixation, representing 92.4% of the case in the cohort. Complication rates for each type were calculated and Kaplan-Meier curves with multivariate Cox regression analysis was used to evaluate the effect of the case characteristics on construct survival rate, while controlling for patient profile. Results: A total of 1073 of 1494 patients eligible for 2-year follow-up (71.8%) were captured. Survival curves for major complications (with or without reoperation), while controlling for demographics differed significantly among surgical types ( P <0.001). Fusion procedures short of the pelvis had the best survival rate, while UT-pelvis with 3CO had the worst survival rate. Longer fusions and more invasive operations were associated with lower 2-year complication-free survival, however, there were no significant associations between type of surgery and renal, cardiac, infection, wound, gastrointestinal, pulmonary, implant malposition, or neurological complications (all P >0.5). Conclusions: This study suggests that there is an inherent increased risk of complication for some types of ASD surgery independent of patient profile. The results of this paper can be used to produce a surgery-adjusted benchmark for ASD surgery with regard to complications and survival. Such a tool can have very impactful applications for surgical decision-making and more informed patient counseling. Level of Evidence: Level III. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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