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• W4386041610 abstract "BACKGROUND CONTEXT Clinical outcomes for adult spinal deformity patients has been extensively reported on, however factors associated with sustaining 2-year (2Y) substantial clinical benefit (SCB) until 5-year (5Y) remains unclear. PURPOSE To evaluate impact baseline and postoperative alignment and patient factors leading to sustenance of SCB. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Prospectively collected operative ASD single center database. OUTCOME MEASURES Health-related quality of life measures (HRQL), complications METHODS Operative ASD patients fused from at least L1 to sacrum with baseline (BL) and 5-year postop (5Y) data were included. Good outcome (GO) was defined as: no reoperation, mechanical failure, proximal junctional failure (PJF) based on Lafage criteria, and (meeting either: 1. SCB for Oswestry Disability Index [ODI] [decrease of >18.8], or 2. ODI 4.5). Outcomes were assessed via ANCOVA adjusting for age, BMI, CCI, frailty, BL deformity (PT, PI, LL, PI-LL, SVA, C7PL,) BL HRQLs, and surgical variations. Multivariable logistic regression controlling for covariates was used to assess factors predictive of GO. RESULTS A total of 330 ASD patients (age 64.1±9.7yrs, 80% F, BMI 27.7±5.7kg/m2, CCI: 1.86±1.71, Passias frailty index 7.7±5.0, BL ODI 46±16, BL SRS 2.7±0.6). Forty-two percent achieved GO at 2Y (2+) while 47% at 5Y (5+) did. A total of 71% of 2+ cohort attained 5+ (30% of total cohort). In 2- cohort, 29% achieved 5+ (17% of total cohort). Complication rates in 2- (vs 2+) by 2Y: overall 72% (44%), 6% (0%) pseudarthrosis, 5% (0%) screw fracture, 17% (5%) rod fracture, 17% PJF, 9% (0%) reop or major neurological complications, 36% reoperations (all p<.05). The 2- cohort had worse SVA at 2Y (3.8±5.7cm vs 1.7±4.2, p<.05). Complications in 5- (vs 5+): 6.2% PJF, 23% (5%) cardiopulmonary complications, 7.4% (3.2%) gastrointestinal complications, 3.5% (1%) adjacent segment disease, 7% (0%) implant failure, 3% neurological complications, 7% pseudarthrosis. The 5- cohort had significantly higher frailty at 2Y and 5Y (p<.05). Isolating 2+ cohort, assessing 5+ vs 5-: 5- had IP corrected to 1 level cranial (at T12 mid body), and greater SVA deformity at 5Y (p<.05). Complications in 2+/5- (vs 2+/5+): 36% (3%) cardiopulmonary complications, 8% (4%) gastrointestinal complications, 9% (5%) infection, 8% (0%) stroke, 5% adjacent segment disease, 12.5% PJF, 15% (1%) rod fracture, 5% reoperation, (all p<.05). Regaining the level of activity postoperatively was associated with 4x higher odds of maintaining GO from 2Y to 5Y (p<.05). Fewer restrictions on social life at 2Y and ability for personal care at BL, 2Y and 5Y had the highest likelihood of meeting 5+ (p<.05). The odds of achieving GO at 5Y in 2+ decreased by 47% for each additional comorbidity and decreased by 74% in those that had lower extremity paresthesias at BL (both p<.05). Back step regression adjusting for baseline patient factors and deformity predicted decreased number of levels fused, decreased correction in SVA and increased correction in PI-LL to be predictive of sustaining 2Y GO till 5Y (levels fused OR: 0.87 [0.76-0.98], p=.028, SVA OR: 0.888 [0.806-0.978], p=.016, PI-LL OR: 1.043 [1.002-1.085], p=.038). CONCLUSIONS Substantial clinical benefit was seen in 47% of patients at 5-years postoperatively. While the majority of patients (71%) at 2-years postoperatively sustained their clinical outcome at 5 years, major contributors to its loss was medical complications, PJF and rod fracture, which was associated with increased frailty at 5 years despite having no difference at baseline and 2 years. Each additional comorbidity decreased the odds of sustaining substantial clinical benefit until 5 years by nearly 50%. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Clinical outcomes for adult spinal deformity patients has been extensively reported on, however factors associated with sustaining 2-year (2Y) substantial clinical benefit (SCB) until 5-year (5Y) remains unclear. To evaluate impact baseline and postoperative alignment and patient factors leading to sustenance of SCB. Retrospective cohort study. Prospectively collected operative ASD single center database. Health-related quality of life measures (HRQL), complications Operative ASD patients fused from at least L1 to sacrum with baseline (BL) and 5-year postop (5Y) data were included. Good outcome (GO) was defined as: no reoperation, mechanical failure, proximal junctional failure (PJF) based on Lafage criteria, and (meeting either: 1. SCB for Oswestry Disability Index [ODI] [decrease of >18.8], or 2. ODI 4.5). Outcomes were assessed via ANCOVA adjusting for age, BMI, CCI, frailty, BL deformity (PT, PI, LL, PI-LL, SVA, C7PL,) BL HRQLs, and surgical variations. Multivariable logistic regression controlling for covariates was used to assess factors predictive of GO. A total of 330 ASD patients (age 64.1±9.7yrs, 80% F, BMI 27.7±5.7kg/m2, CCI: 1.86±1.71, Passias frailty index 7.7±5.0, BL ODI 46±16, BL SRS 2.7±0.6). Forty-two percent achieved GO at 2Y (2+) while 47% at 5Y (5+) did. A total of 71% of 2+ cohort attained 5+ (30% of total cohort). In 2- cohort, 29% achieved 5+ (17% of total cohort). Complication rates in 2- (vs 2+) by 2Y: overall 72% (44%), 6% (0%) pseudarthrosis, 5% (0%) screw fracture, 17% (5%) rod fracture, 17% PJF, 9% (0%) reop or major neurological complications, 36% reoperations (all p<.05). The 2- cohort had worse SVA at 2Y (3.8±5.7cm vs 1.7±4.2, p<.05). Complications in 5- (vs 5+): 6.2% PJF, 23% (5%) cardiopulmonary complications, 7.4% (3.2%) gastrointestinal complications, 3.5% (1%) adjacent segment disease, 7% (0%) implant failure, 3% neurological complications, 7% pseudarthrosis. The 5- cohort had significantly higher frailty at 2Y and 5Y (p<.05). Isolating 2+ cohort, assessing 5+ vs 5-: 5- had IP corrected to 1 level cranial (at T12 mid body), and greater SVA deformity at 5Y (p<.05). Complications in 2+/5- (vs 2+/5+): 36% (3%) cardiopulmonary complications, 8% (4%) gastrointestinal complications, 9% (5%) infection, 8% (0%) stroke, 5% adjacent segment disease, 12.5% PJF, 15% (1%) rod fracture, 5% reoperation, (all p<.05). Regaining the level of activity postoperatively was associated with 4x higher odds of maintaining GO from 2Y to 5Y (p<.05). Fewer restrictions on social life at 2Y and ability for personal care at BL, 2Y and 5Y had the highest likelihood of meeting 5+ (p<.05). The odds of achieving GO at 5Y in 2+ decreased by 47% for each additional comorbidity and decreased by 74% in those that had lower extremity paresthesias at BL (both p<.05). Back step regression adjusting for baseline patient factors and deformity predicted decreased number of levels fused, decreased correction in SVA and increased correction in PI-LL to be predictive of sustaining 2Y GO till 5Y (levels fused OR: 0.87 [0.76-0.98], p=.028, SVA OR: 0.888 [0.806-0.978], p=.016, PI-LL OR: 1.043 [1.002-1.085], p=.038). Substantial clinical benefit was seen in 47% of patients at 5-years postoperatively. While the majority of patients (71%) at 2-years postoperatively sustained their clinical outcome at 5 years, major contributors to its loss was medical complications, PJF and rod fracture, which was associated with increased frailty at 5 years despite having no difference at baseline and 2 years. Each additional comorbidity decreased the odds of sustaining substantial clinical benefit until 5 years by nearly 50%." @default.
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• W4386041610 date "2023-09-01" @default.
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• W4386041610 title "5. Sustenance of substantial clinical benefit in adult spinal deformity corrective surgery patients: a minimum 5-year outcomes analysis" @default.
• W4386041610 doi "https://doi.org/10.1016/j.spinee.2023.06.027" @default.
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