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

R Daniel Bass; Renaud Lafage; Justin S Smith; Christopher Ames; Shay Bess; Robert Eastlack; Munish Gupta; Richard Hostin; Khaled Kebaish; Han Jo Kim; Eric Klineberg; Gregory Mundis; David Okonkwo; Christopher Shaffrey; Frank Schwab; Virginie Lafage; Douglas Burton; International Spine Study Group

doi:10.1097/BRS.0000000000005012

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

Spine (Phila Pa 1976). 2024 Apr 15. doi: 10.1097/BRS.0000000000005012. Online ahead of print.

Authors

R Daniel Bass¹, Renaud Lafage¹, Justin S Smith², Christopher Ames³, Shay Bess⁴, Robert Eastlack⁵, Munish Gupta⁶, Richard Hostin⁷, Khaled Kebaish⁸, Han Jo Kim⁹, Eric Klineberg¹⁰, Gregory Mundis⁵, David Okonkwo¹¹, Christopher Shaffrey¹², Frank Schwab¹, Virginie Lafage¹, Douglas Burton¹³; International Spine Study Group

Affiliations

¹ Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY.
² Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA.
³ Department of Neurosurgery, University of California School of Medicine, San Francisco, CA.
⁴ Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO.
⁵ Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA.
⁶ Department of Orthopedic Surgery, Washington University, St Louis, MO.
⁷ Southwest Scoliosis and Spine Institute, Dallas, TX.
⁸ Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
⁹ Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
¹⁰ Department of Orthopedic Surgery, UTHealth, Hoston, TX.
¹¹ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
¹² Department of Neurosurgery, Duke University Medical Center, Durham, NC.
¹³ Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS.

PMID: 38616765
DOI: 10.1097/BRS.0000000000005012

Abstract

Objective: 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.

Methods: Eight surgical scenarios were defined based on the levels treated, previous fusion status (primary [P] vs. revision [R]), and 3-column osteotomy use [3CO]: Short Lumbar fusion, LT-Pelvis with 5-12 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: 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 neurologic complications (all P>0.5).

Conclusion: 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.