The aim of this study was to determine the independent effects of operative time and surgical invasiveness on perioperative outcomes afterwards spinal fusions for adult spinal deformity. Adult spinal deformity ( ASD ) is common in the adult population, with previous reports estimating that there are over 500,000 adults with curves over 30 ° in the United States
Morbidity is high after posterior fusions for adult spinal deformity. Although previous reports have demonstrated an association between perioperative outcomes and the extent of correction and fusion (number of subsequent levels of fused, pelvic fixation, combined previous-posterior fusion), no study has looked at the independent effects of surgical invasiveness after controlling for operative time
All adult patients, undergoing posterior spinal fusion for spinal deformity, were identified in the 2010 to 2014 National Surgical Quality Improvement Program (NSQIP) database. Multivariate analysis was used to determine the independent effects of longer operative timing and the surgical invasiveness (number of levels fused, previous or transforaminal interbody fusions, osteotomies, and pelvic fixation) on 30-day complications.
Researchers designed a retrospective cohort study. A total of 1540 patients undergoing posterior spinal fusion for adult spinal deformity were identified. The overall rate of complaints was 15.3%. In multivariate analysis, greater operative timing was associated with increased inpatient complications [odds ratio (95% confidence interval, 95% CI) from 2.23 (1.25-3.98) for 7-8 hours to 4.46 (2.61-7.64) for 9+ hours; P <0.001].
Although the number of levels was fused, previous / interbody fusions, osteotomies, and pelvic fixation were associated with bivariate analysis, these factors were not associated with complications in operative time.
For adult deformity surger y, longer operative time appears to be a better predictor of the overall perioperative rate than surgical invasiveness in multivariate analysis. Rather than avoidance of a more extensive and invasive surgical procedure, which may be indicated to improve alignment and stability, these data suggest the importance of safely and minimizing overall operative time.