RT Journal Article
SR Electronic
T1 Comparison of Staged vs Same-Day Circumferential Spinal Fusions for Adult Spinal Deformity
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8548
DO 10.14444/8548
A1 Albayar, Ahmed
A1 Santangelo, Gabrielle
A1 Spadola, Michael
A1 Macaluso, Dominick
A1 Ali, Zarina S.
A1 Saifi, Comron
A1 Heintz, Jonathan
A1 Han, Xiaoyan
A1 Bilker, Warren
A1 Malhotra, Neil
A1 Welch, William C.
A1 Wathen, Connor
A1 Dagli, Mert Marcel
A1 Ghenbot, Yohannes
A1 Yoon, Jang
A1 Arlet, Vincent
A1 Ozturk, Ali K.
YR 2023
UL https://www.ijssurgery.com/content/early/2023/10/09/8548.abstract
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.