PT  - JOURNAL ARTICLE
AU  - Albayar, Ahmed
AU  - Santangelo, Gabrielle
AU  - Spadola, Michael
AU  - Macaluso, Dominick
AU  - Ali, Zarina S.
AU  - Saifi, Comron
AU  - Heintz, Jonathan
AU  - Han, Xiaoyan
AU  - Bilker, Warren
AU  - Malhotra, Neil
AU  - Welch, William C.
AU  - Wathen, Connor
AU  - Dagli, Mert Marcel
AU  - Ghenbot, Yohannes
AU  - Yoon, Jang
AU  - Arlet, Vincent
AU  - Ozturk, Ali K.
TI  - Comparison of Staged vs Same-Day Circumferential Spinal Fusions for Adult Spinal Deformity
AID  - 10.14444/8548
DP  - 2023 Oct 12
TA  - International Journal of Spine Surgery
PG  - 8548
4099  - https://www.ijssurgery.com/content/early/2023/10/09/8548.short
4100  - https://www.ijssurgery.com/content/early/2023/10/09/8548.full
AB  - Background Patients often undergo circumferential (anterior and posterior) spinal fusions to maximize adult spinal deformity (ASD) correction and achieve adequate fusion. Currently, such procedures are performed in staged (ST) or same-day (SD) procedures with limited evidence to support either strategy. This study aims to compare perioperative outcomes and costs of ST vs SD circumferential ASD corrective surgeries.Methods This is a retrospective review of patients undergoing circumferential ASD surgeries between 2013 and 2018 in a single institution. Patient characteristics, preoperative comorbidities, surgical details, perioperative complications, readmissions, total hospital admission costs, and 90-day postoperative care costs were identified. All variables were tested for differences between ST and SD groups unadjusted and after applying inverse probability weighting (IPW), and the results before and after IPW were compared.Results The entire cohort included a total of 211 (ST = 50, SD = 161) patients, 100 of whom (ST = 44, SD = 56) underwent more than 4 levels fused posteriorly and anterior lumbar interbody fusion (ALIF). Although patient characteristics and comorbidities were not dissimilar between the ST and SD groups, both the number of levels fused in ALIF and posterior spinal fusion (PSF) were significantly different. Thus, using IPW, we were able to minimize the cohort incongruities in the number of levels fused in ALIF and PSF while maintaining comparable patient characteristics. In both the whole cohort and the long segment fusions, postoperative pulmonary embolism was more common in ST procedures. After adjustment utilizing IPW, both groups were not significantly different in disposition, 30-day readmissions, and reoperations. However, within the whole cohort and the long segment fusion cohort, the ST group continued to show significantly increased rates of pulmonary embolism, longer length of stay, and higher hospital admission costs compared with the SD group.Conclusions Adjusted comparisons between ST and SD groups showed staging associated with significantly increased length of stay, risk of pulmonary embolism, and admission costs.Level of Evidence 2.