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P95. A comparative analysis of thoracic decompensation versus proximal junctional kyphosis in response to adult spinal deformity corrective surgery [Meeting Abstract]
Imbo, B; Williamson, T; Krol, O; Joujon-Roche, R; Tretiakov, P; Diebo, B G; Vira, S N; Passias, P G; Passfall, L; Schoenfeld, A J; Lafage, R; Lafage, V; Protopsaltis, T S; Daniels, A H; Gum, J L
BACKGROUND CONTEXT: Thoracic decompensation (TD) represents a distinct radiographic complexity from proximal junctional kyphosis (PJK). Few studies exist on the occurrence of TD following adult spinal deformity (ASD) corrective surgery. PURPOSE: To assess the incidence of TD following ASD-corrective surgery in comparison with the occurrence of PJK. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: A total of 689 ASD patients. OUTCOME MEASURES: ASD, TD, PJK, thoracic compensation.
METHOD(S): ASD patients with complete baseline (BL) and two-year (2Y) followup were included. Patients were divided into groups: those who developed TD: T4-T12 >54.2degree and those who developed PJK. Further analysis assessed outcomes among patients with both TD and PJK (TDPJK). Thoracic compensation was defined as expected thoracic kyphosis minus BL thoracic kyphosis. Means comparison tests and multivariable logistic regression analysis assessed differences between patient groups.
RESULT(S): A total of 373 patients met inclusion criteria. Patient breakdown by radiographic outcome was: TD (N=31), PJK (N=223) and TDPJK (N=119). Age, gender, and ASD-mFI were similar between TD and PJK patients. TD patients were more likely to be osteoporotic than PJK patients, p < 0.05. Procedures on TD patients were less invasive and utilized a shorter construct (9.3 vs 11.5 levels; both p < 0.05). TD patients had significantly greater cervical lordosis, thoracic kyphosis, and lumbar lordosis than PJK patients at BL and 2Y follow-up, all p < 0.05. Thoracic compensation was significantly associated with TD (OR 1.07 [CI 1.04-1.09], p < 0.001) controlling for age, ASD-mFI, and invasiveness. TDPJK had the highest complication rate (84.9%), significantly greater than PJK patients (70.9%), and TD patients (61.3%), both p < 0.05. PJK patients were 78.7% less likely to develop PJF than TDPJK patients (OR 0.213 [CI 0.101-0.453], p < 0.001).
CONCLUSION(S): Patients who developed thoracic decompensation were more likely to present with osteoporosis, but had less invasive procedures and levels fused than patients with proximal junctional kyphosis. The tradeoff between fusing too much resulting in proximal junctional kyphosis and fusing too little predisposing to thoracic decompensation can serve as the basis of future studies to determine optimal construct length to balance these two risks. Thoracic compensation was predictive of postoperative thoracic decompensation in adult spinal deformity-correction. Patients who developed TDPJK had the highest rate of complications and greater odds of junctional failure. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright
EMBASE:2019804820
ISSN: 1878-1632
CID: 5510442
P104. Crossing the bridge from degeneration to deformity: when good outcomes necessitate sagittal correction in adult spinal deformity surgery [Meeting Abstract]
Williamson, T; Passias, P G; Imbo, B; Joujon-Roche, R; Tretiakov, P; Krol, O; Lebovic, J; Owusu-Sarpong, S; Dhillon, E S; Vira, S N; Varghese, J J; Schoenfeld, A J; Moattari, K; Diebo, B G; Janjua, M B; Koller, H; Smith, J S; Lafage, R; Lafage, V
BACKGROUND CONTEXT: Patients with less severe adult spinal deformity undergo surgical correction and often achieve good clinical outcomes. However, it is not well understood how much clinical improvement is due to sagittal correction. PURPOSE: Derive baseline thresholds in radiographic parameters that, when exceeded, result in dramatic clinical improvement from surgical correction. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 689 ASD patients. OUTCOME MEASURES: Radiographic alignment, clinical outcomes (ODI SCB).
METHOD(S): ASD patients with BL and 2-year (2Y) data included. Parameters assessed: SVA, PI-LL, PT, T1PA, L4-S1 Lordosis, C2-C7 SVA (cSVA), C2-T3 and C2 Slope (C2S).
Outcome(s): Good Outcome (GO): [Meeting either: 1) SCB for ODI by 2Y (change greater than 18.8), or 2) ODI 4.5 by 2Y. Binary logistic regression assessed each parameter to determine if correction was more likely needed to achieve GO. Conditional inference tree (CIT) run machine learning analysis generated baseline thresholds for each parameter, above which, correction was necessary to achieve GO.
RESULT(S): Included: 447 ASD patients. There were 223 (50%) patients achieving GO by 2 years. Binary logistic regression analysis demonstrated correction of all 5 thoracolumbar parameters (SVA, T1PA, PI-LL, PT, L4-S1) were more often needed to achieve GO (all p.001). Of patients with baseline T1PA above 20degree, 95% required correction to meet Good Outcome (95% vs 54%, p.001). CIT-generated thresholds were significant for each parameter, with a baseline C2 slope above 15degree necessitating correction more often to obtain clinical success (OR: 8.1, [4.1-16.2]; p.001).
CONCLUSION(S): Our study highlights there is a tipping-point beyond which sagittal correction has an exponential influence on clinical improvement, reflecting the line where deformity becomes a significant contributor to disability. These new thresholds delineate patients suitable for sagittal correction, as opposed to conventional treatment of degenerative disc processes. Adherence to these benchmarks may improve the utility gained from surgical intervention for degenerative conditions and deformity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright
EMBASE:2019804138
ISSN: 1878-1632
CID: 5510612
P108. Outcomes of operative treatment for adult cervical deformity: a prospective, multicenter assessment with minimum 2-year followup [Meeting Abstract]
EliasElias; Bess, S; Line, B; Lafage, V; Lafage, R; Klineberg, E O; Kim, H J; Passias, P G; Nasser, Z; Gum, J L; Kebaish, K M; Eastlack, R K; Daniels, A H; Mundis, G M; Hostin, R A; Protopsaltis, T S; Hamilton, D K; Gupta, M C; Hart, R A; Schwab, F J; Burton, D C; Ames, C P; Shaffrey, C I; Smith, J S
BACKGROUND CONTEXT: Adult cervical deformity (ACD) can have profound impact on health-related quality of life (HRQL). Operative treatment for ACD is associated with high complication rates due to the complexity of surgery and the frailty of the patients affected. Very few studies have focused on outcomes of operative ACD treatment. PURPOSE: To assess whether operative treatment for ACD significantly improves HRQL at minimum 2-yr followup. STUDY DESIGN/SETTING: Multicenter, prospective cohort study. PATIENT SAMPLE: Operatively treated ACD patients. OUTCOME MEASURES: Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), EuroQol-5D (EQ-5D), and numeric rating scale (NRS) for neck and back pain.
METHOD(S): Operatively treated ACD patients were assessed at baseline, standardized follow-up intervals and through direct mailings. Patient-reported outcomes measures (PROMs) included: NDI, mJOA, EQ-5D and NRS for neck and back pain. Complications were classified as perioperative (=30 days) or delayed (>30 days). Analyses focused on patients with minimum 2-yr followup.
RESULT(S): Of 169 ACD patients, the 102 (60%) with minimum 2-yr followup (mean=3.4 yrs, SD=1.9 yrs, range=2 to 8.1 yrs) had a mean age of 62 yrs (SD=11) and 64% were women. Surgical approaches included anterior-only (22.8%), posterior-only (39.6%) and combined (37.6%). The mean numbers of vertebrae fused anteriorly and posteriorly were 4.3 (SD=1.1) and 9.4 (SD=3.4), respectively, with 16% having a 3-column osteotomy. PROMs significantly improved from baseline to last follow-up, including NDI (47.3 to 33.0), mJOA (12.0 to 12.8; for patients with baseline score 0.05). Overall, 58 (56.9%) patients had at least 1 complication, 41 (40.2%) had at least 1 perioperative complication, and 35 (34.3%) had at least 1 delayed complication. The most common complications included dysphagia (18.6%), distal junctional kyphosis (6.9%), instrumentation failure (6.9%), cardiac events (6.9%), dysphonia (4.9%), nerve sensory deficit (3.9%) and respiratory failure (3.9%). For patients with at least 2-yr follow-up, 12 patients underwent a total of 15 reoperations (9 had 1 and 3 had 2). Notably, the 67 patients who did not achieve 2-yr follow-up were similar to study patients based on demographics, comorbidities and baseline PROMs. Reflective of the frailty of this patient population, there were 18 deaths among the 67 patients without minimum 2-yr followup. These deaths occurred between 0.2 and 34.8 months following surgery. Although most occurred at least 6 months after surgery and likely were not directly related to surgery, 4 occurred within 4 months of surgery, including 1 due OSA/narcotics, 1 due to pneumonia, and 2 with unknown causes.
CONCLUSION(S): This multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of HRQL at minimum 2-yr (mean 3.4-yr) followup. These findings may prove useful for patient counseling in the context of the substantial impact of ACD. Further studies will be needed to assess the long-term durability and cost-effectiveness of surgical treatment for ACD. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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EMBASE:2019804068
ISSN: 1878-1632
CID: 5510732
P123. Have robotic procedures improved perioperative and long-term outcomes after overcoming the learning curve? A 2-year analysis [Meeting Abstract]
Passias, P G; Krol, O; Imbo, B; Joujon-Roche, R; Tretiakov, P; Williamson, T; Owusu-Sarpong, S; Diebo, B G; Vira, S N
BACKGROUND CONTEXT: Robot-assisted surgical techniques are being increasingly implemented in spine surgery to increase accuracy and mitigate surgeon fatigue. There are known variations in the learning curve required for effective use; however, literature on the effect of robot-assisted techniques on perioperative outcomes, after overcoming the learning curve, remains scarce. PURPOSE: To identify differences in perioperative outcomes and complication rates between robot-assisted and unassisted lumbar interbody fusions (LIFs), and the learning curve based on surgeon caseload. STUDY DESIGN/SETTING: Retrospective review of a single-center stereographic database. PATIENT SAMPLE: A total of 230 robot-assisted lumbar spine fusion surgery patients. OUTCOME MEASURES: Perioperative outcomes [EBL, LOS], postoperative complication rates, radiographic alignment, HRQLs.
METHOD(S): Robot-assisted spinal fusion cases with baseline and up to 2-year HRQL and radiographic followup were isolated from a single-surgeon database. Cases were ranked by the date of surgery into 2 cohorts representing the first and last 50% of cases or early vs late, respectively. Univariate analysis was used to assess baseline, surgical and radiographic profiles of the 2 cohorts.
RESULT(S): A total of 230 patients met inclusion criteria (age: 56+/-12.5, BMI: 30+/-6, 42% female). Average levels fused was 2.3+/-1.5, mean operative time was 281+/-110min, EBL 298+/-274ml and LOS was 3.9+/-2.5. Average UIV was L3 and average LIV L5. Two percent of patients had an ALIF, 36% XLIF/LLIF, 57% TLIF, 6% PLIF and 19% had an osteotomy. The late group was older (58 vs 51 years) and had a higher CCI (1.3 vs.7). The late group had a greater number of levels fused (2.5 vs 1.9, p=.005), greater usage of interbody devices (1.5 vs 1.3, p=.033), more laminectomies (31% vs 10%), less decompressions (51% vs 98%) and more osteotomies (25% vs 13%). Late group had a lower usage of ALIF (5% vs 1%), higher usage of XLIF/LLIF (20% vs 48%), lower usage of TLIF (42% vs 84%). The late group had a lower EBL (272ml vs 331ml, p=.16), shorter op-time (261min vs 302min, p=.03), and comparable LOS (4.3 vs 4.3 p=.74). The late group had a lower rate of discharge to rehab (8% vs 50%, p<.001). Rate of reoperations, readmissions, and overall complications trended lower in the late group. At BL, late group had a comparable ODI (70 vs 64, p=.27) and BL NRS back pain (8.5 vs 8, p=.3). At 3M, late group had a lower ODI (48 vs 59, p=.114) and comparable NRS back (5 vs 5.8, p=.3). At 2-year followup, patients in the late group had a lower ODI (34 vs 42), lower NRS back pain (3.9 vs 5.2), and lower NRS leg pain (3.14 vs 4.2).
CONCLUSION(S): Patients operated on in the second half of surgeons' full robotic case load demonstrated an improved perioperative course in the form of a shorter LOS, lower EBL, shorter operative time and a substantial reduction in proportions of patients discharged to rehabilitation facilities. Outcomes at 2 years show superior recovery as evidenced by lower pain and ODI scores. These findings suggest that once the robotic learning curve is overcome, outcomes may improve substantially. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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EMBASE:2019803915
ISSN: 1878-1632
CID: 5510922
115. Discriminative ability of commonly used contemporary risk indices to predict adverse outcomes following adult spinal deformity corrective surgery [Meeting Abstract]
Williamson, T; Passias, P G; Joujon-Roche, R; Imbo, B; Tretiakov, P; Krol, O; Dave, P; Lebovic, J; Dhillon, E S; Varghese, J J; Diebo, B G; Vira, S N; Owusu-Sarpong, S; Lafage, V
BACKGROUND CONTEXT: It is imperative to determine which factors have greater implications on postoperative outcomes, which can afford tailored treatment plans for adult spinal deformity (ASD) patients. PURPOSE: To determine the discriminative ability of commonly used indices to predict adverse outcomes after corrective surgery for adult spinal deformity. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: This study included 9,763 patients. OUTCOME MEASURES: Perioperative complications.
METHOD(S): ASD patients from the National Surgical Quality Improvement Program (NSQIP) 2005-2015 were included. Logistic regression analysis determined significant odds ratios among complications between the following indices and demographics: Passias et al modified frailty index score for ASD (mFI-ASD), the modified Charlson Comorbidity Index (mCCI), ASA classification score, age and body mass index (BMI). Using multivariate analysis, indices and demographics that demonstrated significance for predicting complications were identified. CIT run forest analysis generated an index threshold value for all complications tested.
RESULT(S): Included: 9,763 ASD patients. At least 4 of the 5 risk indices were significant for the following complications: any type, major, cardiac, infection and death. None of the indices correlated with reoperation or readmission. The mFI-ASD demonstrated the highest odds ratio (OR) for all complications (p <.001), followed by ASA status. Modified CCI also correlated with a higher OR for all five complications, compared to age and BMI. An index threshold value for each complication was determined by CIT run forest analysis. Analysis of threshold values showed mFI had the highest ORs for any complication (OR: 3.50) as well as infection (OR: 2.53). ASA status, on the other hand, had the highest ORs for major complications (OR: 2.93), cardiac complications (OR: 4.09) and death (OR: 10.18).
CONCLUSION(S): The modified FI-ASD demonstrated superiority in predicting adverse postoperative outcomes, compared to various commonly used indices and patient characteristics. These findings are important as it allows spine surgeons to appropriately counsel their patients preoperatively. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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EMBASE:2019804825
ISSN: 1878-1632
CID: 5510432
117. Predictive analysis of risk factors and clinical outcomes of delayed extubation in adult spinal deformity surgery [Meeting Abstract]
Tretiakov, P; Imbo, B; Williamson, T; Krol, O; Joujon-Roche, R; Mir, J; Diebo, B G; Lebovic, J; Vira, S N; Lafage, R; Smith, J S; Lafage, V; Passias, P G
BACKGROUND CONTEXT: Due to the high physiologic stress adult spinal deformity (ASD) surgery often places upon patients, delayed intubation may be considered to prevent decompensation between stages or after surgery. However, previous studies in thoracolumbar patients have demonstrated it may be associated with worsened peri- and postoperative outcomes due to the increased risk of infection or airway edema. Yet, literature regarding predictive analysis of delayed extubation in ASD patients remains scarce. PURPOSE: To identify risk factors and predictors of delayed extubation in ASD patients in order to enhance patient selection and reduce peri- and postoperative complication. STUDY DESIGN/SETTING: Retrospective review of prospective ASD database. PATIENT SAMPLE: This study included 689 ASD patients. OUTCOME MEASURES: Peri- and postoperative complication rates; HRQLs.
METHOD(S): Operative ASD patients 18yrs with complete pre-(baseline [BL]) and 2-year(2Y) postop radiographic/HRQL data were stratified by decision to delay postoperative extubation (Delayed) vs those who were extubated immediately after surgery (Extubated). Differences in demographics, clinical outcomes, and complication rates were assessed via means comparison analysis. Conditional binary backstep logistic regression assessed demographic, surgical, and perioperative predictors of delayed extubation at alpha=.05.
RESULT(S): A total of 582 patients were included (58.11 +/- 11.97 years, 48% female, 29.13 +/- 6.89 kg/m2. Of these patients, 53 (9.1%) were classified as Delayed. When comparing staged vs same-day procedures, 96.2% (n=50) of Delayed patients were classified as same-day. At BL, Delayed patients were comparable in gender, BMI, frailty, and CCI (all p>.05). When assessing individual comorbidities, Delayed patients were significantly more likely to be previously diagnosed with arthritis (58% vs 91%, p=.024). In terms of BL HRQLs, Delayed patients presented with significantly lower scores in SF-36 physical function, general health, and mental health domains (all p.05). Predictive modeling demonstrated that female gender, high CCI, elevated EBL, elevated op time, levels fused and BL anemia were robust predictors of delayed extubation (model p <.001, AUC=.838).
CONCLUSION(S): This study demonstrates that female gender, high CCI, elevated intraoperative blood loss, elevated operative time, levels fused and prior history of anemia is predictive of patients experiencing delayed extubation following corrective spinal deformity surgery resulting in extended SICU and hospital stay. Though no significant difference in postoperative complication rates were noted overall, optimization of patients preoperatively to reduce the risk of delaying extubation should be strongly considered. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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EMBASE:2019803985
ISSN: 1878-1632
CID: 5510832
49. The impact of sagittal alignment on disability decreases after surgery as other factors become more influential: series of 925 patients with two-year follow-up [Meeting Abstract]
Scheer, J K; Lafage, V; Smith, J S; Lafage, R; Passias, P G; Klineberg, E O; Hart, R A; Burton, D C; Line, B; Bess, S; Shaffrey, C I; Schwab, F J; Gupta, M C; Ames, C P; International, Spine Study Group
BACKGROUND CONTEXT: The relationship of sagittal malalignment to outcomes has been emphasized in adult spinal deformity (ASD) surgery and it is known that sagittal parameters have some correlation to HRQOL measures overall. However, the specific relationship of HRQOL to postop sagittal alignment and changes in the strength of the relationship from preop to postop for deformity surgery has not been well defined. PURPOSE: To determine how postop health-related quality of life (HRQOL) correlates to sagittal alignment. STUDY DESIGN/SETTING: Retrospective analysis of a large prospective multicenter ASD database. PATIENT SAMPLE: This study included 925 ASD patients. OUTCOME MEASURES: HRQOL: Oswestry Disability Index (ODI), Short-Form-36 (SF-36), and Scoliosis Research Society-22r (SRS-22r). Radiographic sagittal alignment thresholds for C7-S1 sagittal vertical axis (SVA), pelvic tilt (PT), mismatch between pelvic incidence and lumbar lordosis (PI-LL).
METHOD(S): Adult (=18yrs), Cobb angle =20degree, SVA=5cm, PT=25degree, and/or thoracic kyphosis=60degree, 2-yr follow up. Pts were grouped by having met 2/3 of the sagittal alignment thresholds (SVA,PT, and/or PI-LL) at 2 years postop for either the SRS-Schwab values (+SS0) or age-adjusted values (+AGE). The age-adjusted values were calculated within +/-10 years of their actual age. The groups -SS0 and -AGE were patients who didn't meet 2/3 of the SRS-Schwab or the age-adjusted values, respectively. Baseline/2-year HRQOL were evaluated via linear regression for all groups based on 2-year correction.
RESULT(S): Total 925 pts, mean age 60.1+/-14.2yrs, 602(65.1%)+SS0, 323(35.9%)-SS0, 199(21.5%)+AGE, and 283(30.6%)-AGE pts. The remaining age-adjusted pts were either overcorrected or did not have 2/3 sagittal values matched (n=443). All pts had significant improvement in all HRQOL at 2 years and for each of the subgroups (p <0.001 for all). The overall baseline R2 values for all pts for SVA, PI-LL and PT with ODI were (0.110, 0.072, 0.043, respectively) and at 2 years they were lower (0.049, 0.016, 0.008, respectively). Of the pts with pelvic fixation (n=635,68.6%), the same 2-year R2 values increased slightly but were still very weak (0.058, 0.028, 0.021, respectively). Of the pts who developed PJK, the 2-year R2 values were (PJK: 0.007, 0.024, 0.004, noPJK: 0.057, 0.017, 0.006, respectively). This same trend of low values was observed in +/-SS0 and +/-AGE pts. However, the R2 for 2-year ODI vs MCS, SRS appearance, and SRS mental, increased postop (0.19, 0.43, 0.22, respectively) compared with preop (0.17, 0.25, 0.17, respectively).
CONCLUSION(S): Sagittal alignment correlates weakly with preop HRQOL and postop HRQOL is improved. Preop SVA explains only 11% of preop ODI scores based on the R2 value and this decreases postop to 5%. After alignment correction, other patient factors become increasingly important such as the relationship between ODI and SRS appearance, SRS mental, and MCS. More work is necessary to better understand the postop HRQOL relationships including the possibility of a better measurement tool for surgical success. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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EMBASE:2019804744
ISSN: 1878-1632
CID: 5510512
55. Bone morphogenetic protein (BMP) use in adult spinal deformity surgery is associated with reduced implant failures and lower cost/QALY at mean four years postoperative [Meeting Abstract]
Bess, S; Line, B; Ames, C P; Burton, D C; Eastlack, R K; Mundis, G M; Gum, J L; Lafage, V; Lafage, R; Klineberg, E O; Daniels, A H; Gupta, M C; Hamilton, D K; Kelly, M P; Kebaish, K M; Passias, P G; Protopsaltis, T S; Hart, R A; Kim, H J; Schwab, F J; Shaffrey, C I; Smith, J S; International, Spine Study Group
BACKGROUND CONTEXT: Despite studies reporting the efficacy of BMP to promote surgical spinal fusion, hospital systems and third-party payors continue to deny use of BMP, claiming high cost and lack of long term follow up. PURPOSE: Perform a propensity score matched analysis of complications and cost-effectiveness for surgically treated adult spinal deformity (ASD) patients receiving BMP vs no BMP. STUDY DESIGN/SETTING: Prospective, multicenter, propensity score matched analysis. PATIENT SAMPLE: ASD patients enrolled into a prospective multicenter study. OUTCOME MEASURES: Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), cost of care, cost/QALY, postoperative complications.
METHOD(S): Surgically treated ASD patients prospectively enrolled into a multicenter study from 2009-2018 were assessed for receiving BMP or NOBMP (iliac crest bone graft and allograft only) at the time of surgery. BMP and NOBMP cohorts were propensity score matched (PSM) for age, BMI, frailty, total levels fused, fusion to the pelvis, osteotomies, interbody fusion and supplemental rod use. Postoperative alignment, complications, rod fractures, patient-reported outcomes (PROMs), cost of care (based on DRG reimbursements adjusted to 2021 US dollars), were evaluated at minimum 3-year follow-up, and cost/QALY calculated at 1-,2-, and minimum 3-year follow-up.
RESULT(S): Of 888 patients, 483 (mean 4.2 years follow-up, range 2.9 to 8.8) were evaluated. Mean BMP dosage was 27.6 mg total (range 1 to 200), 2.2 mg/level posterior (range 0 to 25) and 1.7 mg/level interbody (range 0 to 18). BMP (n=407) had similar demographics, osteotomies, total and interbody levels fused, preop PROMs, follow-up duration, and pre- and postoperative spinal alignment as NOBMP (n=76; p>0.05). BMP had fewer implant failures (0.17/patient vs 0.33/patient; p 0.05). At last follow-up, BMP had better SF-36 social function (46.7 vs 43.9) and SF-36 mental component scores (51.5. vs 47.8) than NOBMP (p <0.05, respectively). BMP had lower mean total cost of care/patient ($78,679.61 vs $103,388.78) and lower cost/QALY ($22,455.48 vs $32,947.68) at last follow-up vs NOBMP, respectively (p < 0.05). Revision surgery rates were similar for BMP vs NOBMP (0.32 vs 0.42/patient, p=0.11); however, costs of revision surgery were less for BMP ($11,114.33) vs NOBMP ($22,912.53, p <0.05).
CONCLUSION(S): Propensity score matched analysis demonstrated BMP use in ASD surgery at mean 4-year follow-up was associated with decreased implant fracture rates, lower treatment costs and better cost/QALY than NOBMP. Hospital systems, administrators and third-party payors should consider that the initial cost of BMP use at index surgery may be offset by decreased total cost of care and improve cost/QALY for ASD patients. FDA DEVICE/DRUG STATUS: Bone morphogenetic protein: Investigational.
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EMBASE:2019804738
ISSN: 1878-1632
CID: 5510522
167. Neurologic outcomes of adult spinal deformity patients with baseline preoperative lower extremity weakness: will they improve following surgery? [Meeting Abstract]
Hassan, F; Lenke, L G; Burton, D C; Daniels, A H; Gupta, M C; Hostin, R A; Kebaish, K M; Kelly, M P; Kim, H J; Klineberg, E O; Lewis, S J; Passias, P G; Protopsaltis, T S; Schwab, F J; Shaffrey, C I; Smith, J S; Line, B; Lafage, V; Bess, S; International, Spine Study Group; Lafage, R
BACKGROUND CONTEXT: Adult spinal deformity (ASD) patients undergoing surgery risk neurological decline following surgery. However, surgery may be the key in improving outcomes in patients starting with lower extremity motor deficits at baseline (BL). We aim to analyze the improvement in neurological outcomes of ASD patients undergoing spinal reconstruction with BL and 6-week postoperative lower extremity motor scores (LEMS). PURPOSE: The aim of this study is to analyze the improvement in neurological outcomes of adult patients undergoing deformity surgery with baseline abnormal LEMS. STUDY DESIGN/SETTING: Multicenter, prospective cohort. PATIENT SAMPLE: A total of 205 patients were included in the study. OUTCOME MEASURES: Patient and procedural factors that lead to the improvement in neurological outcomes of adult patients undergoing deformity surgery with baseline abnormalLEMS.
METHOD(S): ASD patients ages = 18 were prospectively studied from 2018-2021. All patients underwent an instrumented PSF with a few also having an ASF of the lumbar spine. Patients were dichotomized based on BL LEMS (NML = 50, ABML < 50). The ABNML group was then dichotomized based on whether LEMS improved overall from BL or experienced no change or declined by first postoperative follow-up (PO) and various factors were analyzed and compared using standard statistical tests.
RESULT(S): Of the 205 patients evaluated, 134 (65.4%) were NML and 71 were ABNML (34.3%) at BL. Among the 71 patients with ABML LEMS at BL, 49% (N=35) improved to NML levels, 21% (N=15) improved from BL levels but not to NML, 20% (N=14) remained the same, and 10% (N=7) declined further at 6week PO. Compared to ABNML patients with no change or a decline in LEMS at first PO, patients who improved overall (70%; N=50) had significantly more decompressions performed (86% vs 57%; p=0.0092), and had more PCOs performed intraoperatively (90% vs 62%, p=0.0074). There were no statistical differences between the groups in age, BL LEMS, BMI, total instrumented vertebrae (TIV), EBL, and OR time. Overall, the number of patients with NML LEMS at 6 weeks PO increased by 7.5% (65.4% to 70.2%; p<.0001).
CONCLUSION(S): Seventy percent of patients with ABML LEMS at BL improved their motor strength by the first PO visit, while 30% stayed the same or declined. ABNML patients who improved from BL had significantly more decompressions performed and, surprisingly, more PCOs performed. Interestingly, patient factors between the two groups demonstrated no statistical differences further highlighting that improvement may be influenced by the differences in surgical techniques. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright
EMBASE:2019804125
ISSN: 1878-1632
CID: 5510622
Defining age-adjusted spinopelvic alignment thresholds: should we integrate BMI?
Passias, Peter G; Segreto, Frank A; Imbo, Bailey; Williamson, Tyler; Joujon-Roche, Rachel; Tretiakov, Peter; Krol, Oscar; Naessig, Sara; Bortz, Cole A; Horn, Samantha R; Ahmad, Waleed; Pierce, Katherine; Ihejirika, Yael U; Lafage, Virginie
PURPOSE/OBJECTIVE:To develop age- and BMI-adjusted alignment targets to improve patient-specific management and operative treatment outcomes. METHODS:Retrospective review of a single-center stereographic database. ASD patients receiving operative or non-operative treatment, ≥ 18y/o with complete baseline (BL) ODI scores and radiographic parameters (PT, SVA, PILL, TPA) were included. Patients were stratified by age consistent with US-Normative values (norms) of SF-36(< 35, 35-55, 45-54, 55-64, 65-74, ≥ 75y/o), and dichotomized by BMI (Non-Obese < 30; Obese ≥ 30). Linear regression analysis established normative age- and BMI-specific radiographic thresholds, utilizing previously published age-specific US-Normative ODI values converted from SF-36 PCS (Lafage et al.), in conjunction with BL age and BMI means. RESULTS:486 patients were included (Age: 52.5, Gender: 68.7%F, mean BMI: 26.2, mean ODI: 32.7), 135 of which were obese. Linear regression analysis developed age- and BMI-specific alignment thresholds, indicating PT, SVA, PILL, and TPA to increase with both increased age and increased BMI (all R > 0.5, p < 0.001). For non-obese patients, PT, SVA, PILL, and TPA ranged from 10.0, - 25.8, - 9.0, 3.1 in patients < 35y/o to 27.8, 53.4, 17.7, 25.8 in patients ≥ 75 y/o. Obese patients' PT, SVA, PILL, and TPA ranged from 10.5, - 7.6, - 7.1, 5.8 in patients < 35 y/o to 28.3, 67.0, 19.15, 27.7 in patients ≥ 75y/o. Normative SVA values in obese patients were consistently ≥ 10 mm greater compared to non-obese values, at all ages. CONCLUSION/CONCLUSIONS:Significant associations exist between age, BMI, and sagittal alignment. While BMI influenced age-adjusted alignment norms for PT, SVA, PILL, and TPA at all ages, obesity most greatly influenced SVA, with normative values similar to non-obese patients who were 10 years older. Age-adjusted alignment thresholds should take BMI into account, calling for less rigorous alignment objectives in older and obese patients.
PMID: 35657561
ISSN: 2212-1358
CID: 5236222