52. Patients with additional medical comorbidities failed to maintain MCID+ status at five years following adult spinal deformity surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Evidence on long-term maintenance of health status in adult spinal deformity (ASD) patients who improve above MCID threshold (MCID+) at 2 years following surgery is limited. <h3>PURPOSE</h3> This study aims to: (1) evaluate whether patients who reached MCID+ status at two years postoperatively will maintain MCID+ status at 5 years, (2) identify risk factors associated with maintaining MCID+ status, and (3) Assess whether maintaining MCID+ status at 5 years is associated with satisfaction with surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> Patients who underwent adult spinal deformity (ASD) surgery with minimum 5-year follow-up who achieved 2-year MCID in ODI were identified. <h3>OUTCOME MEASURES</h3> Maintenance of MCID+ status at 5 years for Oswestry Diability Index (ODI). <h3>METHODS</h3> Patients who maintained MCID+ status at 5 years and those who did not formed the comparison groups. Multivariable logistic regression, controlling for age, complications after two years and two-year alignment, was used to identify risk factors associated with the inability to maintain MCID+ status. In a separate multivariable logistic regression, whether maintaining MCID+ status was associated with 5-year surgical satisfaction was assessed. <h3>RESULTS</h3> Of 633 eligible patients, 339 had 5-year data. Of 133 with both 2- and 5-year data, 70 who achieved 2-year MCID in ODI were included. 30% (21) failed to maintain MCID+ status at 5 years. Preoperatively, 33% (23) were narcotic users, 47% (33) were frail and mean surgical invasiveness was 96.6±36.02. On multivariable logistic regression, preoperative variables were assessed: CCI > 3 (OR 5.75; p=0.026), ASA grade > 2 (OR 5.25; p=0.015), anemia (OR 19.74; p=0.009), and cancer (OR 6.46; p=0.015) were associated with increased odds of failure to maintain MCID+ status at 5-year follow-up. Patients who failed to maintain MCID+ status at 5 years had a higher odds of being unsatisfied with the surgery (OR 15.66; p=0.001). Frailty and surgical invasiveness had no significant impact on MCID+ status at 5 years. <h3>CONCLUSIONS</h3> Preoperative comorbid conditions significantly impact patient's long-term ability to maintain the positive gains in health-related quality of life measures from the surgery. Surgeons should continue to monitor and treat the chronic conditions to ensure maintenance of long-term recovery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.