P89. Do readmissions and reoperations adversely affect patient-reported outcomes associated with complex adult spinal deformity surgery at a minimum 2-year postoperative?

Abstract

BACKGROUND CONTEXT Unplanned readmissions and reoperations are known to be associated with undesirable costs and outcomes in ASD surgery. Few prior studies have examined predictors for readmissions and reoperations at 2-year followup and the impact on patient-reported outcomes (PROs) in this population. PURPOSE To examine the impact of 2-year Readmissions/Reoperations on HRQoL Scores for Complex ASD surgical patients. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Complex adult spinal deformity surgery patients. OUTCOME MEASURES Readmissions, reoperations, complications, and patient-reported outcomes at 2-year minimum follow-up. METHODS Consecutively collected adult (>=18years) patients who underwent complex spinal deformity surgery at a single institution from 2015 to 2018. Minimum 2year follow up. Missing data removed. Univariate and multivariate analyses performed on perioperative factors (eg, demographics, comorbidities, operative) and outcomes (eg, complications, readmissions, PROs). RESULTS A total of 175 patients (72% female, mean age 52.6+-16.4) with a minimum follow-up of 2 years underwent complex ASD surgery. The mean total instrumented/fused levels was 13.3 (4.1), range 6 to 25. The readmission and reoperation rates were 16.6% and 12%, respectively. The top reasons for reoperation were pseudarthrosis (5.1%), proximal junctional kyphosis (5.1%), and implant failure (3.4%). At 2 years, 86.4% and 68.2% of patients reached MCID for SRS and ODI, respectively. Patients who did not require a readmission had significantly higher PROs compared to preoperative values (SRS 87.1 vs 65.2) and those who required a readmission (SRS 87.1 vs 78.8) at 1-year follow-up. Those who required a readmission had significant increases in SRS and reductions in ODI at 2 years (SRS 90.6, ODI 17.7) compared to 1 year (SRS 78.8, ODI 26) and preoperative baseline values (SRS 60.4, ODI 44.9). Significant risk factors for readmissions within 2 years included pulmonary comorbidity (OR5.6, p=0.004), depression (OR4, p=0.018), gastroenterology comorbidity (OR11.9, p CONCLUSIONS The 2-year readmission and reoperation rates following complex ASD surgery was 16.6% and 12% respectively with readmissions most often related to pseudarthrosis, PJK, and implant failure requiring reoperations. However, readmitted and revised patients significantly improved their HRQoL scores at 2 years compared to preoperative baseline and 1-year values. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.