Impact of early unanticipated revision surgery on health-related quality of life after adult spinal deformity

Publication date: Available online 13 October 2017
Source:The Spine Journal
Author(s): Susana Núñez-Pereira, Alba Vila-Casademunt, Montse Domingo-Sàbat, Juan Bagó, Emre R. Acaroglu, Ahmet Alanay, Ibrahim Obeid, Francisco Javier Sánchez Pérez-Grueso, Frank Kleinstück, Ferran Pellisé
Background contextRevision surgery represents a major event for patients undergoing ASD surgery. Previous reports suggest minimal or no impact on HRQOL outcomes.PurposeTo investigate the impact of early reoperations within the first year on health-related quality of life (HRQOL) and on the likelihood of reaching the MCID after ASD surgery.DesignRetrospective analysis of prospectively collected data from consecutive surgically treated adult deformity surgery (ADS) patients included in a multicenter, international database.Patient sampleTwo hundred eighty patients from a multicenter international prospective database.Outcome measureODI; SF-36; SRS-22; MCIDMethodsConsecutive surgical ASD patients recruited prospectively in 6 different centers from 4 countries with a minimum 2-year follow-up were stratified into 2 groups: R (revision surgery within the first year) and NR (no revision). HRQOL (ODI, SF36, SRS22) was assessed and compared at 6-month, 1-year and 2-year follow-up stages. Statistical analysis included chi-square tests, Student's t-tests and linear mixed models.ResultsForty-three patients(R Group) received 46 revision surgeries. 19 (41.3%) had implant-related complications, 9 (19.6%) deep surgical site infections, 9 (19.6%) proximal junctional kyphosis, 3 (6.5%) hematoma, and 6 (13%) had other complications. Baseline characteristics differed between groups.At six months, all HRQOL scores improved in both groups, except in the SF-36 MCS and SRS-22 mental health domain in the R group. At one year, ODI and SRS-22 improvement was significantly greater in the NR group, exceeding the reported minimal clinically important difference (MCID). At the two-year follow-up, ODI, SRS-22, SF-36 MCS and SF-36 PCS improvement was similar in both groups. However, postoperative change was only above the MCID for SF-36 PCS, ODI and SRS-22 in the NR group.ConclusionEarly unanticipated revision surgery has a negative impact on mental health at 6 months and reduces the chances of reaching an MCID improvement in SRS-22, SF-36 PCS and ODI at the 2-year follow-up.



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