P86. Patients with high preoperative activity are still satisfied at two-years following ASD surgery despite the potential for postoperative functional decline

Abstract

BACKGROUND CONTEXT Adult Spinal Deformity (ASD) surgery significantly improves disability in patients who are functionally limited. Few studies have been done examining the threshold at which surgery is unlikely to provide functional benefit in ASD patients. PURPOSE To identify a preoperative threshold at which patients who are more active than this threshold are unlikely to have functional improvement following ASD surgery, and may experience functional decline. STUDY DESIGN/SETTING Retrospective review of a multicenter database. PATIENT SAMPLE A total of 592/760 (78%) eligible ASD patients (>5 levels fused) were identified in a multicenter database with minimum 2-year follow-up. OUTCOME MEASURES Our primary outcome was baseline-2 year postoperative change in Scoliosis Research Society 22r (SRS-22r) Activity domain. METHODS The SRS-22r was administered at preoperatively and at follow-up visits through 2-years. A baseline SRS-22r Activity score threshold was identified at which patients were more likely to decline than improve at 2-years postoperatively. Categorical variables were compared with chi-squared test. Significance was set at 0.05. RESULTS Mean age of patients was 59±14 years, 80% females. Patients had 11.2±4.3 levels fused; follow up of 3.8±0.9 years. A baseline SRS-22r threshold of 3.8 was identified at which 44 (52%) patients above this threshold declined and 40 (48%) had improved activity at 2-year follow-up. In patients who declined, mean change was -0.6±0.43 points. Patients above this threshold were younger, had less severe deformity, and less back/leg pain (p CONCLUSIONS Baseline SRS-22r Activity score can be used to risk-stratify ASD patients by likelihood of functional improvement postoperatively. Patients doing better than this threshold are just as likely to be satisfied as more disabled patients at 2 years, likely due to improvement in appearance, pain or mental health rather than activity level. In patients with SRS-22r activity above 3.8, the potential for minimal functional benefit should be included in the shared decision making process. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.