30. Outcomes analysis of staged vs same day surgery patients undergoing identical cervical deformity corrective surgery

Abstract

BACKGROUND CONTEXT Surgical intervention aimed at addressing adult cervical deformity (ACD) is an invasive and complex procedure that surgeons often elect to perform on different days. Despite patients undergoing staged procedures being older, with more comorbidities, staged patients had superior short- and long-term outcomes while undergoing less osteotomies, possibly leading to the overall decrease in complications. PURPOSE To determine differences in outcomes between staged vs same-day procedures. STUDY DESIGN/SETTING Retrospective cohort study of single-center database. PATIENT SAMPLE A total of 65 CD patients. OUTCOME MEASURES Complications; radiographic parameters; HRQL metrics (Neck Disability Index [NDI], EQ5D, mJOA, Numerical Rating Score [NRS] neck and back pain). METHODS Inclusion criteria: operative CD patients (cervical kyphosis>10°, with cSVA>4cm or CBVA>25°) and >18yrs undergoing either staged or same-day procedures. Significant differences in surgical, radiographic and clinical factors and outcomes were determined. RESULTS A total of 65 CD patients met inclusion criteria (58.3 years, 46% Female, 28.3 kg/m2). Overall, 32 (48%) of these patients underwent staged procedures, while 33 (52%) underwent a same-day combined approach. Staged patients were older (61 vs 56, p=.03) and had a higher CCI (1 vs .63, p=.13). Patients that had a staged procedure experienced fewer overall complications (22% vs 43%, p=.002) and less neurological complications (p<0.05). Staged patients had an overall lower usage of osteotomies (25% vs 53%, p=.02). Staged patients had a lower 6W NDI score (47 vs 56, p=.16), lower 3M NSR Neck (5.5 vs 6.6) and Back pain score (5.2 vs 5.9), lower 6M NSR Neck (3.5 vs 5.2), back pain score (3.4 vs 5.6) and NDI score (30 vs 40). At 2-years follow-up, staged patients had a lower NSR neck (3.6 vs 6.2), back pain score (4.4 vs 7.4), NDI score (28 vs 43, all p<0.05) and higher mJOA/SWAL scores. CONCLUSIONS Staged procedures have become more prevalent as surgeons aim to decrease perioperative adverse events and improve patient outcomes. Despite patients undergoing staged procedures being older, with more comorbidities, staged patients had superior short- and long-term outcomes while undergoing less osteotomies, possibly leading to the overall decrease in complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Surgical intervention aimed at addressing adult cervical deformity (ACD) is an invasive and complex procedure that surgeons often elect to perform on different days. Despite patients undergoing staged procedures being older, with more comorbidities, staged patients had superior short- and long-term outcomes while undergoing less osteotomies, possibly leading to the overall decrease in complications. To determine differences in outcomes between staged vs same-day procedures. Retrospective cohort study of single-center database. A total of 65 CD patients. Complications; radiographic parameters; HRQL metrics (Neck Disability Index [NDI], EQ5D, mJOA, Numerical Rating Score [NRS] neck and back pain). Inclusion criteria: operative CD patients (cervical kyphosis>10°, with cSVA>4cm or CBVA>25°) and >18yrs undergoing either staged or same-day procedures. Significant differences in surgical, radiographic and clinical factors and outcomes were determined. A total of 65 CD patients met inclusion criteria (58.3 years, 46% Female, 28.3 kg/m2). Overall, 32 (48%) of these patients underwent staged procedures, while 33 (52%) underwent a same-day combined approach. Staged patients were older (61 vs 56, p=.03) and had a higher CCI (1 vs .63, p=.13). Patients that had a staged procedure experienced fewer overall complications (22% vs 43%, p=.002) and less neurological complications (p<0.05). Staged patients had an overall lower usage of osteotomies (25% vs 53%, p=.02). Staged patients had a lower 6W NDI score (47 vs 56, p=.16), lower 3M NSR Neck (5.5 vs 6.6) and Back pain score (5.2 vs 5.9), lower 6M NSR Neck (3.5 vs 5.2), back pain score (3.4 vs 5.6) and NDI score (30 vs 40). At 2-years follow-up, staged patients had a lower NSR neck (3.6 vs 6.2), back pain score (4.4 vs 7.4), NDI score (28 vs 43, all p<0.05) and higher mJOA/SWAL scores. Staged procedures have become more prevalent as surgeons aim to decrease perioperative adverse events and improve patient outcomes. Despite patients undergoing staged procedures being older, with more comorbidities, staged patients had superior short- and long-term outcomes while undergoing less osteotomies, possibly leading to the overall decrease in complications.