PMID- 37450674 OWN - NLM STAT- Publisher LR - 20230714 IS - 1528-1159 (Electronic) IS - 0362-2436 (Linking) DP - 2023 Jul 13 TI - Critical Analysis of Radiographic and Patient Reported Outcomes Following Anterior/Posterior Staged vs. Same Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity. LID - 10.1097/BRS.0000000000004774 [doi] AB - STUDYDESIGN: Retrospective cohort study of a prospectively collected multi-center adult spinal deformity (ASD) database. OBJECTIVE: To compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for treatment of ASD. BACKGROUND: Surgical intervention for ASD is invasive and complex procedure that surgeons often elect to perform on different days (staging). Yet, there remains a paucity of literature on the timing and effects of the interval between stages. METHODS: ASD patients with two-year (2Y) data undergoing an anterior/posterior (A/P) fusion to the ilium were included. Propensity score matching (PSM) was performed for number of levels fused, number of interbody devices, surgical approaches, number of osteotomies/three-column osteotomy (3CO), frailty, Oswestry Disability Index (ODI), Charlson Comorbidity Index (CCI), revisions, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), and UIV to create balanced cohorts of Same-Day and Staged surgical patients. Staged patients were stratified by intervening time-period between surgeries, using quartiles. RESULTS: 176 PSM patients were included. Median interval between A/P staged procedures was 3 days. Staged patients had greater operative time and lower ICU stays postop (P<0.05). At 2Y, staged compared to same day showed a greater improvement in T1 slope - cervical lordosis (TS-CL), C2 sacral slope (C2SS), and SRS-Schwab SVA (P<0.05). Staged patients had higher rates of minimal clinically-important difference (MCID) for 1Y SRS-Appearance and 2Y physical component summary (PCS) scores. Assessing different intervals of staging, patients at the 75th percentile interval showed greater improvement in 1Y SRS Pain and Total postop as well as SRS Activity, Pain, Satisfaction, and Total scores (P<0.05) compared to patients in lower quartiles. Compared to the 25th percentile, patients reaching the 50th percentile interval were associated with increased odds of improvement in Global Alignment and Proportion (GAP) score proportionality (9.3[1.6-53.2], P=0.01). CONCLUSIONS: This investigation is among the first to compare multicenter staged and same day surgery anterior/posterior adult spinal deformity patients fused to ilium using propensity-matching. Staged procedures resulted in significant improvement radiographically, reduced ICU admissions, and superior patient reported outcomes compared to same day procedures. An interval of at least three days between staged procedures is associated with superior outcomes in terms of GAP score proportionality. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Passias, Peter G AU - Passias PG AD - Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA. FAU - Ahmad, Waleed AU - Ahmad W AD - Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA. FAU - Tretiakov, Peter S AU - Tretiakov PS AD - Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA. FAU - Lafage, Renaud AU - Lafage R AD - Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA. FAU - Schoenfeld, Andrew J AU - Schoenfeld AJ AD - Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA. FAU - Line, Breton AU - Line B AD - Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA. FAU - Daniels, Alan AU - Daniels A AD - Department of Orthopedics, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA. FAU - Mir, Jamshaid M AU - Mir JM AD - Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA. FAU - Gupta, Munish AU - Gupta M AD - Department of Orthopaedic Surgery, Washington University, St. Louis, MO. FAU - Mundis, Gregory AU - Mundis G AD - Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, CA. FAU - Eastlack, Robert AU - Eastlack R AD - Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA. FAU - Nunley, Pierce AU - Nunley P AD - Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, LA. FAU - Hamilton, D Kojo AU - Hamilton DK AD - Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. FAU - Hostin, Richard AU - Hostin R AD - Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, Texas, USA. FAU - Hart, Robert AU - Hart R AD - Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA. FAU - Burton, Douglas C AU - Burton DC AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas. FAU - Shaffrey, Christopher AU - Shaffrey C AD - Department of Neurosurgery, Duke University Medical Center, Durham, NC. FAU - Schwab, Frank AU - Schwab F AD - Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA. FAU - Ames, Christopher AU - Ames C AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA. FAU - Bess, Shay AU - Bess S AD - Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA. FAU - Klineberg, Eric O AU - Klineberg EO AD - Department of Orthopaedic Surgery, University of California, Davis, Davis, CA. CN - International Spine Study Group LA - eng PT - Journal Article DEP - 20230713 PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 SB - IM COIS- The authors report no conflicts of interest. EDAT- 2023/07/14 19:07 MHDA- 2023/07/14 19:07 CRDT- 2023/07/14 14:53 PHST- 2023/02/27 00:00 [received] PHST- 2023/06/30 00:00 [accepted] PHST- 2023/07/14 19:07 [medline] PHST- 2023/07/14 19:07 [pubmed] PHST- 2023/07/14 14:53 [entrez] AID - 00007632-990000000-00415 [pii] AID - 10.1097/BRS.0000000000004774 [doi] PST - aheadofprint SO - Spine (Phila Pa 1976). 2023 Jul 13. doi: 10.1097/BRS.0000000000004774.