Assistant Professor of Neurological Spine Surgery University of Florida Gainesville, FL, US
Introduction: It is unclear if the site of the most recent surgery has an impact on outcomes following revision adult spinal deformity(ASD) surgery. We sought to assess for differences in outcomes, complications, and patient reported outcome measures(PROMs) between revision patients from an outside center(OC) and those from the same center(SC).
Methods: A retrospective review of a single-center database was performed to identify ASD patients undergoing revision surgery with a minimum of 2yr follow-up. Site of most recent operation, patient and operative characteristics, complications, and PROMs, specifically the SRS-22r and ODI, were collected and analyzed.
Results: 149 patients were included (SC=29, OC=120). OC had a greater number of prior surgeries(2.6±3.5 vs 1.7±1.5,p=0.038) and fewer previously instrumented levels(9.1±5.2 vs 11.8±5.4,p=0.018). SC were more likely to present with implant failure(41% vs 20%,p=0.016), while OC were more likely to present with malalignment(78.3% vs 55.2%,p=0.0109), curve progression(41% vs 17%,p=0.018), and DJK(23% vs 4%,p=0.015). OC had longer OR times(8.3±2.1hrs vs 5.8±2.2hrs,p < 0.0001), greater EBL(1548±793cc vs 886±633cc,p < 0.0001), and more changes to the LIV(62% vs 24%,p=0.0003) with more OC being extended to the pelvis(50% vs 17%,p=0.0014). Although, OC had a greater LOS(8.6±16.1d vs 5.2±3.2d,p=0.031). OC had a lower overall postoperative complication rate(43% vs 72%,p=0.005) with the biggest comparison being among the pseudarthrosis(OC: 14% vs SC: 35%,p=0.011). OC were less likely to RTOR(28% vs 62%,p=0.0004). OC had greater improvement in total SRS-22r scores(0.9±1.3 vs 0.1±1.2, p=0.021) as well as in the self-image(1.3±1.0 vs 0.7±1.3,p=0.0397), mental health(0.4±0.9 vs -0.1±0.9,p=0.0361), and satisfaction domains(1.7±1.3 vs 0.3±1.2,p=0.0001). Interestingly, OC patients had lower baseline levels of satisfaction(2.6±1.1 vs 3.5±1.3,p < 0.0001).
Conclusion : ASD patients coming from an outside center had greater improvement in PROMs and lower postoperative complication rates despite a higher mean number of prior surgeries, more complex revision operations, and greater LOS. The reason for these differences is unclear but may hinge on higher baseline dissatisfaction
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