Three-Column Osteotomy for Frail Versus Nonfrail Patients with Adult Spinal Deformity: Assessment of Medical and Surgical Complications, Revision Surgery Rates, and Cost

Abstract

Three-column osteotomy (3-CO) is a powerful tool for spinal deformity correction but has been associated with substantial risk and surgical invasiveness. It is incompletely understood how frailty might affect patients undergoing 3-CO. The PearlDiver database was used to examine spinal deformity patients with a diagnosis of frailty who had undergone 3-CO. Frail and nonfrail patients were matched, and the revision surgery rates, complications, and hospitalization costs were calculated. Logistic regression was used to account for possible confounding variables. Of the 2871 included patients, 1460 had had frailty and 1411 had had no frailty. The frail patients were older, had had more comorbidities (P < 0.001), and were more likely to have undergone posterior interbody fusion (P < 0.05), without differences in the anterior interbody fusion rates. No differences were found in the reoperation rates for ≤5 years. At 30 days, the frail patients were more likely to have experienced acute kidney injury (P= 0.018), bowel/bladder dysfunction (P= 0.014), cardiac complications (P= 0.006), and pneumonia (P= 0.039). At 2 years, the frail patients were also more likely to have experienced bowel/bladder dysfunction (P= 0.028), cardiac complications (P< 0.001), deep vein thrombosis (P= 0.027), and sepsis (P= 0.033). The cost for the procedures was also higher for the frail patients than for the nonfrail patients ($24,544.79 vs. $21,565.63; P= 0.043). We found that frail patients undergoing 3-CO were more likely to experience certain medical complications and had had higher associated costs but similar reoperation rates compared with nonfrail patients. Careful patient selection and surgical strategy modification might alter the risks of medical and surgical complications after 3-CO for frail patients.