When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions

作者：Peter G. Passias, Peter Tretiakov, Oluwatobi Onafowokan, Ankita Das, Renaud Lafage, Justin S. Smith, Breton Line, Pratibha Nayak, Bassel Diebo, Alan H. Daniels, Jeffrey L. Gum, D. Kojo Hamilton, Thomas J. Buell, Alex Soroceanu, Justin K. Scheer, Robert K. Eastlack, Jeffrey P. Mullin, Andrew J. Schoenfeld, Gregory M. Mundis, Naobumi Hosogane, Mitsuru Yagi, Praveen V. Mummaneni, Dean Chou, Kai-Ming Fu, Khoi D. Than, Neel Anand, David O. Okonkwo, Michael Y. Wang, Eric O. Klineberg, Khaled M. Kebaish, Stephen J. Lewis, Richard A. Hostin, Munish C. Gupta, Lawrence Lenke, Han Jo Kim, Christopher P. Ames, Christopher I. Shaffrey, Shay Bess, Frank Schwab, Virginie Lafage, Douglas Burton · 发表于：Journal of Neurosurgery Spine · 年份：2024 · DOI：10.3171/2024.8.spine24365 · 被引用次数：5 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Total Knee Arthroplasty Outcomes

OBJECTIVE: The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery. METHODS: Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts. Backstep logistic regression and conditional inference tree analysis were used to identify variable thresholds associated with study-specific definitions of an optimal outcome in each cohort, defined as no intraoperative or surgery-related in-hospital adverse event. RESULTS: There were 439 patients with complex ASD in the dataset (mean age 64.0 ± 9.3 years, 68% female, mean BMI 28.7 ± 5.5 kg/m2). Overall, 58.8% of patients were in the same-day group, while 41.2% were in the staged group. Demographically, cohorts were not significantly different (p > 0.05), but staged patients were more frail per total Edmonton Frail Scale score (p = 0.043). Staged patients also reported greater numeric rating scale scores for back pain than same-day patients (p = 0.002). Cohorts were comparable in magnitude of planned correction of C7-S1 sagittal vertical axis, pelvic incidence-lumbar lordosis (PI-LL) mismatch, and T4-12 kyphosis (all p > 0.05). Controlling for baseline age, fra...