Abstract

In cases of adult spinal deformity (ASD) with severe sagittal malalignment, the use of osteotomies may be necessary in addition to posterior fusion. However, little data exists describing the impact of osteotomies on complications and quality outcomes during ASD surgery.We queried the MarketScan database to identify patients who underwent ASD surgery from 2007-2016. Patients were stratified into whether or not an osteotomy was used in the index operation. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between osteotomy and non-osteotomy patients. Patients under the age of 18 years and those with any prior history of trauma or tumor were excluded from this study.7423 patients met the inclusion criteria of this study, of which n = 2700 (36.4%) received an osteotomy. After PSM, baseline comorbidities and approach type were similar between cohorts. The overall 90-day complication rate was 43.2% in non-osteotomy patients and 52.8% in osteotomy patients (p < 0.0001). The osteotomy cohort also had significantly higher rates of revision surgeries through 2 years (21.1% vs 18.0%, p < 0.05) following index surgery. Three-column osteotomy patients had the highest procedural payments, costing $155,885 through 90-days and $167,161 through 1 year following surgery.This analysis confirms high costs as well as complication, readmission and reoperation rates until two years after ASD surgery in general, which are even higher in cases where an osteotomy is required. Further research should explore strategies for optimizing patient outcomes following osteotomy.

View details for DOI 10.1016/j.wneu.2020.09.072

View details for PubMedID 32956883