BACKGROUND CONTEXT Strategies for ASD surgery evolve over time based on patient populations, experience and new knowledge and techniques. Complication rates remain high for these surgeries and understanding how these practice changes may affect complication types and rates is important for ongoing efforts to improve the safety of care. PURPOSE To assess the evolution of ASD surgery practice patterns over the past decade and whether this has impacted the rates and types of complications STUDY DESIGN/SETTING Retrospective review of prospective multicenter database. PATIENT SAMPLE ASD patients from a prospective multicenter database. OUTCOME MEASURES Surgical practice patterns and complication types and rates. METHODS ASD patients treated surgically from 2008-2016 with a minimum 2-year follow-up were identified from a prospective multicenter database. Demographics, comorbidities, radiographic parameters, surgical data and complications were collected. For assessment of practice pattern and complication changes over time, 3 intervals were created: 2008-2010 (n=199), 2011-2013 (n=202), and 2014-2016 (n=197). RESULTS A total of 598 patients met inclusion (mean age 58.9 yrs, 78% women, 27.4% revision surgery). The overall cohort had high preoperative disability that significantly improved at 2-years postoperative (SRS-22: 2.8 to 3.78, p 0 for SVA (49.5% vs 63.3% vs 60.3%, p=0.034) and PI-LL (51.8% vs 67.8% vs 68.5%, p=0.001). Over time use of posterior-only approach increased (62.3% vs 78.2% vs 77.2%, p=0.003), length of fusion increased (p CONCLUSIONS In this large multicenter ASD series, ASD surgery practice patterns have significantly evolved over the past decade. Over enrollment period, patients treated surgically are older and have greater comorbidities and more severe sagittal malalignment. Use of posterior-only approaches and osteotomies has increased overtime but overall complication rates have remained stable. Change in practice in the year 2011-2013 was associated to a peak in PSO use, instrumentation failures, and severe PJK. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.