Faculty Bibliography

BACKGROUND CONTEXT: Substantial adult spinal deformity (ASD) research has focused on sagittal plane radiological assessment and emphasized the importance of sagittal correction on patient-reported outcomes. It seems less attention has been given to evaluation of ASD in the coronal plane. However, recent ASD studies have demonstrated baseline global coronal malalignment (GCM; substantial displacement of the C7 coronal plumb line from midsacrum) in up to 35% of patients. Moreover, GCM can worsen postoperatively or may occur as an iatrogenic complication in previously balanced patients. Collectively, this may suggest that the associated clinical impact of GCM on ASD surgical outcomes has been underestimated. Currently, few reports focus on surgical outcomes in ASD patients with GCM. PURPOSE: Our objective was to assess treatment outcomes and complication rates associated with ASD surgery in the subset of patients with severe GCM. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected multicenter consecutive case registry. PATIENT SAMPLE: Enrollment required: age >=18 years, scoliosis >=20degree, sagittal vertical axis (SVA) >=5cm, pelvic tilt >=25degree, and/or thoracic kyphosis >=60degree. OUTCOME MEASURES: Radiographic correction (both standard coronal and sagittal spinopelvic deformity measurements) and health-related quality of life (HRQL) outcomes, which included Oswestry Disability Index (ODI), Short Form-36 (SF-36) scores, Scoliosis Research Society-22 (SRS-22) scores, and back/leg pain numerical rating scale (NRS) scores.
METHOD(S): Surgically treated ASD patients with severe GCM (coronal C7PL-midsacral offset magnitude >=1 SD above the mean) were identified. Baseline and follow-up radiographic and HRQL outcomes were analyzed. Percentages of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were assessed. Demographic, frailty, surgical, and complications data were collected. The primary focus for analysis was on patients who reached minimum 2-year follow-up.
RESULT(S): Of 691 potentially eligible operative patients (mean GCM = 4+/-3 cm), 80 met criteria for severe GCM >= 7cm. Of these 80 patients, 62 (78%, mean age 64 years, 81% women) had minimum 2-year follow-up. Baseline frailty score was 3.9+/-1.5 (indicating patients were frail) and 48% had prior spine fusion. Surgical data included: posterior-only (58%), mean fusion 13 levels, sacroiliac fixation (97%), and three-column osteotomy (36%). Postoperative biplane alignment improved significantly (p<0.001): GCM 11 to 4 cm, lumbar Cobb 30degree to 11degree, C7-S1 SVA 13 to 4 cm, and PI-LL 31degree to 5degree. Overall HRQL improved significantly (p<=0.003): ODI 51 to 37, SF-36 PCS 29 to 37, SRS-22r 2.6 to 3.5, and back/leg pain NRS 7 to 4 and 5 to 3, respectively. Thresholds for MCID/SCB were met in 43-83% of patients. A total of 89 complications were reported (34 minor/55 major), and 45 (73%) patients had >=1 complication (most commonly rod fracture [19%] and PJK [18%]). There were 34 reoperations in 22 (36%) patients (most common indications rod fracture/PJK). The 18 patients who did not achieve 2-year follow-up had a mean of 0.63 years follow-up, and the types of complications encountered in these 18 patients were comparable to those encountered in patients with 2-year follow-up.
CONCLUSION(S): ASD surgery for patients with severe GCM is associated with significant improvements in biplane alignment and HRQL outcome measures despite high complication rates. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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PURPOSE/OBJECTIVE:Analysis of interactions of spinal alignment metrics may uncover novel alignment parameters, similar to PI-LL. This study utilized a data-driven approach to hypothesis generation by testing all possible division interactions between spinal alignment parameters. METHODS:This study was a retrospective cohort analysis. In total, 1439 patients with baseline ODI were included for hypothesis generation. In total, 666 patients had 2-year postoperative follow-up and were included for validation. All possible combinations of division interactions between baseline metrics were assessed with linear regression against baseline ODI. RESULTS:From 247 raw alignment metrics, 32,398 division interactions were considered in hypothesis generation. Conceptually, the TPA divided by PI is a measure of the relative alignment of the line connecting T1 to the femoral head and the line perpendicular to the sacral endplate. The mean TPA/PI was 0.41 at baseline and 0.30 at 2 years postoperatively. Higher TPA/PI was associated with worse baseline ODI (p < 0.0001). The change in ODI at 2 years was linearly associated with the change in TPA/PI (p = 0.0172). The optimal statistical grouping of TPA/PI was low/normal (≤ 0.2), medium (0.2-0.4), and high (> 0.4). The R-squared for ODI against categorical TPA/PI alone (0.154) was directionally higher than that for each of the individual Schwab modifiers (SVA: 0.138, PI-LL 0.111, PT 0.057). CONCLUSION/CONCLUSIONS:This study utilized a data-driven approach for hypothesis generation and identified the spino-pelvic ratio (TPA divided by PI) as a promising measure of sagittal spinal alignment among ASD patients. Patients with SPR > 0.2 exhibited inferior ODI scores. LEVEL OF EVIDENCE/METHODS:III.

PURPOSE/OBJECTIVE:Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. METHODS:Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. RESULTS:Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. CONCLUSIONS:Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.

BACKGROUND CONTEXT: While advances have been made in the surgical management of distal junctional kyphosis (DJK), complication rates remain high. Although individual factors related to its occurrence have been cited, many of these cases are mild and have no clinical relevance nor have these been combined into a formal predictive model, particularly for cases that are clinically impactful. PURPOSE: Develop a formal predictive model distinguishing between symptomatic and asymptomatic DJK. STUDY DESIGN/SETTING: Retrospective review PATIENT SAMPLE: A total of 99 cervical deformity patients (CD) with 1 year (1Y) follow up OUTCOME MEASURES: Complications; reoperations; HRQL, alignment METHODS: CD patients (pts) were stratified into asymptomatic (Asym) and symptomatic (Sym) DJK. DJK angle (DJKA) was defined >10degree change in kyphosis between LIV and LIV-2 and a >10degree index angle. Asym: DJK to be>10degree in the absence neurologic sequelae. Sym: 1) DJKA> 10degree and either reop due to DJK or >one new-onset neurological sequelae related to DJK or 2) pts who had either a DJKA > 20degree or DJKA > 20degree. Stepwise logistic regressions were used to identify patient-specific, surgical, radiographic and HRQL factors that were associated with these types of DJK. Decision tree analysis established cut-offs for the continuous variables.
RESULT(S): A total of 99 CD pts were included (60yrs, 26.5kg/m2, 66.7%F). Surgical characteristics: 7.4+/-4 levels fused, 47.5% posterior, 18.2% anterior, and 34.3% combined. Overall, 32.2% developed DJK (34.3% Asym, 65.7% Sym). 37.5% of Asym pts received a reop vs 62.5% Sym pts. At BL, Asym pts had a greater BMI (28.5 vs 23kg/m2) and NSR back pain (5.2 vs 4.6; all p<0.05). Decision tree analysis identified osteoporosis, UIV level, and the apex of the region of the spine where the primary deformity is located to predict Sym pts. Top factors predicting Sym pts over Asym were BL EQ5D>0.65, UIV cephalad to C2, and C2-C7 apex caudal to C5. Multivariate analysis identified independent radiographic and surgical factors for developing Sym DJK: [Radiographic] BL PI (1.02[0.9-1.07]), preop cervical flexibility (1.04[1.01-1.07]); [Surgical] combined approach (6.2[1.4-27]; all p<0.05). Having abnormal hyper kyphosis in the thoracic spine, more so than abnormal cervical lordosis, was an independent factor for developing Sym when analyzed against Asym pts (1.2[0.01-115]). Predictive modeling identified factors that were predictive of Sym against no DJK pts such as having myelopathy (mJOA score:12-14), combined approach, UIV=C3 or C4, preoperative hypermobility, and >7 levels fused (AUC: 0.89). A predictive model for Sym versus Asym pts yielded an AUC of 85% and included being frail, having a TS-CL>20, and a PI>46.3. Controlling for BL deformity and disability, Sym pts had greater cSVA(4-8cm: 47.6%vs 27%) and were more maligned according to their SRS-SVA (0.1[0.76-0.02]) than non DJK pts at 1Y (all p<0.05). Despite their symptomatology and higher re-operation rate, outcomes equilibrated in the Sym cohort at 1Y following revision.
CONCLUSION(S): Overall 32.2% cervical deformed patients suffered from DJK most of which were clinically significant. Severe symptomatic DJK can be predicted with high reliability using combined determinants of baseline spinal cord dysfunction, mobility, frailty, and surgical factors including end levels, number of levels fused and use of a combined approach. It can be further distinguished from asymptomatic occurrences by taking into account pelvic incidence and baseline cervicothoracic deformity severity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: For surgical adult spinal deformity (ASD) patients, determining optimal restoration of alignment and spinal shape is an active area of research. Complex corrective measures taken are in ASD. Incidence of specific alignment outcomes has yet to be investigated in each of the complex realignment ideals. PURPOSE: Assess alignment outcomes (pelvic nonresponse [PNR], PJK, postop cervical deformity [CD]) following ASD-corrective surgery in the context of correction relative to various alignment schemas. STUDY DESIGN/SETTING: Retrospective cohort study of prospective ASD database. PATIENT SAMPLE: A total of 468 ASD patients. OUTCOME MEASURES: PNR, PJK, postop CD.
METHOD(S): ASD patients with preop, 6-week postop (6W), and 2-year postop (2Y) radiographic data included. PNR: 10-year mismatch (undercorrection; unimproved) from a patient's age-adjusted PT at 6W and maintained at 2Y. Pelvic responder (PR): PT +/-10 match age-adjusted goals. Patients were stratified by incremental additions of corrective alignment schemas: (a) improvement in Schwab SVA, (b) matching age-adjusted PI-LL, (c) match postop "ideal" and "theoretical" Roussouly, (d) improvement in proportionality spinal score at 6W. PNR, PJK, and CD development by 2Y were compared within groups, as well as simultaneous improvement/match of the suggested corrective measures (exclusively). In a subanalysis, patients were stratified by severity of baseline PT, low (<20degree), moderate (20-30degree), and severe (>30degree) to determine which alignment schema is necessary to achieve less PNR, PJK and postop CD.
RESULT(S): A total of 468 patients (56.3 yrs, 76.5% F; 25.6% PNR, 40.6% PR) met inclusion criteria. Rates of postop PJK (PNR:49.2% vs PR:59.5%) and CD (18.3% vs 25.8%) were significantly less in the PNR group, p<0.05. Sole improvement in Schwab SVA (73.2%) did not impact PNR, PJK or CD (p>0.050). Undercorrected age-adjusted PI-LL presented with more PNR (60.1%), whereas overcorrected had increased PJK (68.2%), p<0.001. Matching Roussouly at 6W decreased PNR (17.8% vs mismatch:42.3%, p=0.002). 6W proportional spine, had lower rates of PNR (19.7%, severely disproportioned: 58.8%, p<0.001), with postop moderately disproportioned GAP with highest rates of PJK (p=0.010). Incremental addition of alignment schemas was assessed for effect on malalignment outcomes. Schwab and age-adjusted use (20.9%) had less incidence of PNR (28.6% vs 38.7%) than just Schwab. Addition of the Roussouly (18.3%) presented with less PNR (20% vs 30.4%) and PJK (38.5% vs 60.3%) than only Schwab & age-adjusted. Lastly, addition of proportion (16.7%) had 0% occurrence of PNR and CD. Stratifying by baseline PT severity, the low group demonstrated the least incidence of PNR (7.7%) and CD (10.3%) and PJK (41.3%) when matching theoretical Roussouly at 6W (all p<0.050). This remained the same for moderate PT for PNR and PJK, except Schwab improvement decreased postop CD occurrence (21.2%, p=0.049). Severe PT assessment determined PNR (20%), PJK (37.5%) and CD (19.4%) were the lowest with improvement of proportion at 6W (p<0.050).
CONCLUSION(S): Following ASD corrective surgery, 25.6% of patients showed residual pelvic malalignment, qualifying as pelvic nonresponders. Use of complex realignment schemas (SRS-Schwab, age-adjusted, Roussouly shape, GAP) decreased rates of pelvic nonresponse, PJK and postop cervical deformity development. Severe (>30degree) baseline pelvic tilt requires particular emphasis of proportionality in addition to other realignment ideals. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Neurologic complications following adult spinal deformity (ASD) are common and may play a role in the outcomes for our patients. Neurologic complications may include radiculopathy, sensory deficit or motor weakness. The impact that these specific complications have on HRQL is unknown. PURPOSE: Neurologic complications are common following ASD. Understanding their impact on Health-related quality of life (HRQL) measures is critical. STUDY DESIGN/SETTING: Retrospective cohort study of prospective ASD database. PATIENT SAMPLE: Retrospective cohort study, 733 patients. OUTCOME MEASURES: Neurologic complications, HRQL scores.
METHOD(S): ASD patients (>18yrs, scoliosis >=20degree, SVA >=5cm, PT >=25degree and/or TK >60degree). Inclusion criteria was HRQL at baseline (BL) and 1 year, and lower extremity motor score (LEMS) at BL, 6-week and 1-year ODI, SRS22r and SF36 were determined at BL and 1yr LEMS was calculated from 0-50, with 50 designated as normal motor function. Patients were divided into 4 groups: pLEMS (perfect, no deficit), dLEMS (new postop deficit that returned to normal at 1 year), iLEMS (deficit improved from abnormal baseline), and wLEMS (new postop deficit persistent at one year).
RESULT(S): A total of 733 patients were eligible, with 95 (12.96%) reporting neurologic complications (NC). Impact of any NC vs no complication at 1yr was significant for ODI (5.1), PCS (3.6) and SRSpain (0.2) at 1 year (p<0.001 all). For NC vs any other complication, there was still a decrease in ODI (3.9) and PCS (2.4) at 1 year (p<0.01). NC subtype: radiculopathy caused worse outcomes for (4.3) and SRS pain (0.3) (p<0.05), sensory deficit caused worse SRSmental (0.5) (p<0.05), but no HRQL change was detected for motor deficit at 1 year. PLEMS (456/733) had improvement in all HRQL, and these improvements were not different with or w/o NC, or non-NC. Compared to pLEMS w/o complication, dLEMS (62/733) and iLEMS (147/733) were statically similar, however wLEMS (68/733) had worse ODI (7.1), SRStotal (0.3), activity (0.3), mental (0.3), pain (0.3) (p<0.05 all).
CONCLUSION(S): Neurologic complications that occur following ASD have a significant effect on HRQLs. The magnitude of effect is driven by radiculopathy and by lower extremity motor score. LEMS scores that remain normal, return back to normal or improve have similar outcomes, while patients that have continued weakness remain statistically worse at 1 year. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Opioid use prior to surgery is associated with worse postop outcomes. Little is known regarding the economic impact that preop opioid use has upon patient preferred health state, quality adjusted life years (QALYs) and the cost/QALY of surgical treatment for adult spinal deformity (ASD). PURPOSE: Compare the health state preference values, QALYs, and cost/QALY for operatively treated ASD patients that used opioids vs did not use opioids prior to surgery. STUDY DESIGN/SETTING: Cost/QALY analysis of operatively treated patients identified from a prospective, multi-center ASD study. PATIENT SAMPLE: Propensity score matched (PSM) cohorts of patients that used opioids (OPIOID) vs nonusers (NON) prior to ASD surgery, at 1- and minimum 2-year follow up. OUTCOME MEASURES: Short Form-36v2 questionnaire (SF-36), SF6D derived from SF-36, hospital costs for operative treatment of ASD based on CMS DRG reimbursements, QALYs, cost/QALY for index surgery, perioperative complications, and 1- and 2-year postop opioid use.
METHOD(S): ASD patients (age>18 years) enrolled into a prospective multicenter ASD database were divided into preop opioid (OPIOID) vs nonopioid (NON) users. PSM was performed to control for confounding demographic, radiographic, and surgical variables. Preop, 1-year, and minimum 2-year postop SF6D values obtained, 1- and 2-year post QALYs were calculated using SF6D change from baseline, hospital costs at the time of index surgery were calculated using CMS DRG reimbursements adjusted for inflation to 2019 US dollars, cost/QALY evaluated at 1- and 2-years postop, perioperative complications, and 1- and 2-year postop opioid use was evaluated for OPIOID vs NON.
RESULT(S): DRG data was available for 182/262 patients meeting inclusion criteria. Following PSM, preoperative demographics, radiographic parameters, surgical treatment, and mean follow up (3.4 vs 3.3 years) were similar for OPIOID (n=68) vs NON (n=114), respectively (p>0.05). OPIOID had longer ICU (49 vs 23 hours) and hospital stay (9.7 vs 6.8 days) than NON, respectively (p<0.05). SF6D was worse for OPIOID at preop (0.521 vs 0.598), 1-year (0.613 vs 0.749), and 2-years postop (0.626 vs 0.749) than NON, respectively (p<0.05). QALYs were worse at 1- (0.567 vs 0.674) and 2-years postop (0.674 vs 0.825) for OPIOID vs NON, respectively (p<0.05). Cost of care at index surgery was greater for OPIOID ($83,363.02) vs NON ($70,281.17). Cost/QALY was higher for OPIOID at 1-year ($150,294.51vs $107,947.19) and 2-years postoperative ($69,615.78 vs $48,761.14) than NON (p<0.05). Perioperative complications were similar for OPIOID vs NON (p>0.05). Continued opioid use at 2-years postop was greater for OPIOID (52.4%) vs NON (8.7%; p>0.05).
CONCLUSION(S): Opioid use prior to ASD surgery is associated with worse patient perceived health state and greater costs to society. After controlling for patient demographics, deformity magnitude, and type of surgery, OPIOID had greater cost of care, despite similar perioperative complication rates. At 2-years postop both OPIOID and NON demonstrated cost effectiveness of index surgery (cost/QALY<$100,000), however the residual cost to society was $21,300 greater for OPIOID vs NON. Over 52% of OPIOD had continued opioid usage at 2-years postop compared to 8.7% of NON. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Numerous strategies are used to minimize PJK in (ASD). The use of PPS is one such strategy. Studying this topic is difficult as there is a lack of homogeneity in the patient population being studied. PURPOSE: Investigate if PPS minimizes the risk of perioperative PJK compared to traditional open techniques. STUDY DESIGN/SETTING: Retrospective review of prospective multicenter adult spinal deformity database PATIENT SAMPLE: Inclusion criteria are age >18, and one of the following: PT>25, PI-LL>10, or SVA>5 cm. OUTCOME MEASURES: NRS leg, ODI, SF-12, EQ5D, SRS-22.
METHOD(S): A prospective database was retrospectively reviewed. Inclusion criteria are age >18, and one of the following: PT>25, PI-LL>10, or SVA>5 cm. Patients were grouped as MIS (all PPS no open component) or OPEN. Propensity matching was used to create 2 equal groups controlling for: age, BMI, Preop (PI-LL, PI, TPA), and post op (PI-LL correction and posterior levels fused). PJK was evaluated in 2 groups: Mild (PJK10) 10degree change from preop and severe (PJK20) a 20degree change, as previously reported.
RESULT(S): A total of 1,023 patients met criteria: 114 MIS and 909 OPEN. MIS were older with higher BMI. No significant difference was found between groups in preop alignment or SRS Schwab classification. OPEN had more levels fused (11.3 vs 5.5), change in PI-LL (14.9 vs 9.3) and LL (16.2 vs 9.7; all p<0.01). After matching: 77 patients in each group with no difference in demographics or levels fused (6.26 +/- 3.7 OPEN; 6.23 +/- 3.4 MIS). At 1YR NRS leg, ODI, SF-12, EQ5D, SRS-22 were equal. MIS had improved NSR Back compared to OPEN (2.6 vs 3.4; p=0.047). Alignment (PI-LL, TPA, SVA, LL, PT, PI) showed no difference preop, 6 weeks or at 1YR. PJK10 was 23.9% OPEN v 20.3% in MIS at 6 weeks and 28.6% and 19.5% at 1 YR (p>0.59). PJK20 was 2.6% in OPEN vs 3.9% in MIS at 1YR (p=1). The PJK angle was not different (4.3 v 4.2). MIS had less EBL (510 v 1574 cc; p=0.000) longer OR time (448 v 373 min; p=0.022) and more interbodies (3.4 vs 2.1; p=0.000). There was no difference in rate of revision surgery (14.3% OPEN vs 10.4%). Major complications occurred more frequently in OPEN (23.4% vs 9.1%).
CONCLUSION(S): While the use of percutaneous fixation intuitively seems protective for PJK, our study found that when controlling for radiographic deformity, deformity correction, demographics and the magnitude of surgical intervention that percutaneous fixation is equivalent to open techniques in rate of perioperative PJK. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Although researchers have extensively studied factors predicting clinical outcomes at static time points, assessing rate of recovery after adult spinal deformity (ASD) surgery has largely been ignored. This study aims to address this gap in knowledge by evaluating the impact of frailty and invasiveness on recovery kinetics, using area-under-the-curve (AUC) methodology. PURPOSE: To assess the impact of patient specific and surgical factors on postoperative recovery kinetics. STUDY DESIGN/SETTING: Retrospective review of a prospective, multicenter database. PATIENT SAMPLE: A total of 320 patients were identified from a multicenter database who had minimum 2-year HRQOL follow-up, with preoperative, 6-week and 1-year data available. OUTCOME MEASURES: Our primary outcome measure was integrated health state (IHS) score, a marker of postoperative recovery.
METHOD(S): ASD patients with minimum 2-year follow-up were stratified by frailty and surgical invasiveness. Previously validated ASD-FI scores were used to separate non-frail (<.3) patients from those that there were frail (.3 to.5) and severely frail (>.5). Patients were also stratified by surgical inverness, using ASD-SR, into four quartiles, Q1: <65, Q2: 66-89, Q3: 90-119, Q4: >120. Patient demographics, BMI, CCI and surgical parameters were also collected. To assess recovery kinetics, SRS-22r and ODI scores at 6-weeks, 1-year and 2-year were normalized against preoperative values and graphed as a function of time. AUC was summed across all time points to generate a single IHS score. Multivariate linear regression was used with IHS scores as primary outcome variable.
RESULT(S): A total of 320 patients met the inclusion and exclusion criteria. The mean (SD) patient age was 58.6 (14.7) with 79% female. Overall, 139 were non-frail, 131 frail and 46 severely frail. On univariate analysis, frail and severely frail patients were noted to have worse baseline and 2-year HRQOL scores for SRS pain, activity and ODI; however, when comparing differences in HRQOL across this 2-year period, F and SF were noted to have greater improvements in both SRS and ODI (p<.05). On multivariate regression, frail and severely frail patients, compared to those non-frail, were found to have better IHS scores for ODI, SRS-22r pain, and SRS-22r activity, indicating more favorable recovery (p<.05). In particular, for SRS-22r activity, frail (adjusted beta: 0.37, p=<.01) and severely frail (adjusted beta: 0.74, p=<.01) patients were found to have higher IHS compared to their non-frail counterparts. Similarly, for SRS-22r pain, frail and severely frail patients showed improved recovery with higher IHS scores in comparison to non-frail patients. In contrast to frailty, operative variables, including surgical invasiveness and EBL, were insignificant predictors of IHS scores for either ODI or SRS-22r domains.
CONCLUSION(S): Our results suggest that patient-specific factors, namely frailty, play a larger role in predicting postoperative recovery kinetics, in comparison to surgical factors, which appear to have limited if any impact. Despite frail patients having lower preoperative and 2-year HRQOL scores, they were noted to have higher IHS scores SRS pain, activity, and ODI indicating more favorable recovery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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