PMID- 37685633 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230911 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 12 IP - 17 DP - 2023 Aug 26 TI - Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery. LID - 10.3390/jcm12175565 [doi] LID - 5565 AB - BACKGROUND: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. OBJECTIVE: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. STUDY DESIGN/SETTING: Retrospective cohort study of a prospectively collected multicenter database. METHODS: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. RESULTS: A total of 930 patients were considered. Following PSM, 253 "optimal" (O) and 253 "not optimal" (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. CONCLUSIONS: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success. FAU - Passias, Peter G AU - Passias PG AUID- ORCID: 0000-0002-1479-4070 AD - Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, NY 10003, USA. FAU - Williamson, Tyler K AU - Williamson TK AUID- ORCID: 0000-0003-2584-291X AD - Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, NY 10003, USA. FAU - Mir, Jamshaid M AU - Mir JM AUID- ORCID: 0000-0003-3032-3225 AD - Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, NY 10003, USA. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia, Charlottesville, VA 22904, USA. FAU - Lafage, Virginie AU - Lafage V AUID- ORCID: 0000-0002-0119-7111 AD - Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA. FAU - Lafage, Renaud AU - Lafage R AD - Department of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, USA. FAU - Line, Breton AU - Line B AUID- ORCID: 0000-0003-0395-1066 AD - Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO 80205, USA. FAU - Daniels, Alan H AU - Daniels AH AD - Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA. FAU - Gum, Jeffrey L AU - Gum JL AD - Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, KY 40202, 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 02120, USA. FAU - Hamilton, David Kojo AU - Hamilton DK AD - Departments of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. FAU - Soroceanu, Alex AU - Soroceanu A AD - Department of Orthopaedic Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada. FAU - Scheer, Justin K AU - Scheer JK AD - Department of Neurosurgery, University of California, San Francisco, CA 94143, USA. FAU - Eastlack, Robert AU - Eastlack R AD - Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA. FAU - Mundis, Gregory M AU - Mundis GM AD - Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA. FAU - Diebo, Bassel AU - Diebo B AD - Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA. FAU - Kebaish, Khaled M AU - Kebaish KM AD - Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. FAU - Hostin, Richard A Jr AU - Hostin RA Jr AD - Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX 75243, USA. FAU - Gupta, Munish C AU - Gupta MC AD - Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA. FAU - Kim, Han Jo AU - Kim HJ AD - Department of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, USA. FAU - Klineberg, Eric O AU - Klineberg EO AD - Department of Orthopedic Surgery, University of California Davis, Sacramento, CA 95819, USA. FAU - Ames, Christopher P AU - Ames CP AD - Department of Neurosurgery, University of California, San Francisco, CA 94143, USA. FAU - Hart, Robert A AU - Hart RA AD - Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA 98122, USA. FAU - Burton, Douglas C AU - Burton DC AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA. FAU - Schwab, Frank J AU - Schwab FJ AD - Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - Spine Division, Departments of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA. 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 80205, USA. FAU - On Behalf Of The International Spine Study Group AU - On Behalf Of The International Spine Study Group AD - Rocky Mountain Scoliosis and Spine, Denver, CO 80124, USA. LA - eng PT - Journal Article DEP - 20230826 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC10488913 OTO - NOTNLM OT - Medicare OT - adult spinal deformity OT - clinical improvement OT - complex realignment OT - complications OT - cost-utility COIS- The authors declare no conflict of interest. EDAT- 2023/09/09 11:46 MHDA- 2023/09/09 11:47 PMCR- 2023/08/26 CRDT- 2023/09/09 01:08 PHST- 2023/06/26 00:00 [received] PHST- 2023/08/22 00:00 [revised] PHST- 2023/08/22 00:00 [accepted] PHST- 2023/09/09 11:47 [medline] PHST- 2023/09/09 11:46 [pubmed] PHST- 2023/09/09 01:08 [entrez] PHST- 2023/08/26 00:00 [pmc-release] AID - jcm12175565 [pii] AID - jcm-12-05565 [pii] AID - 10.3390/jcm12175565 [doi] PST - epublish SO - J Clin Med. 2023 Aug 26;12(17):5565. doi: 10.3390/jcm12175565.