Scoliosis Research Society-22r Questionnaire Research Articles

Comparative study of low-density versus high-density pedicular screw implantations in management of adolescent idiopathic scoliosis: a randomized clinical trial

BackgroundA number of studies have yielded disparate findings regarding the relationship between implant density and curve correction in adolescent idiopathic scoliosis (AIS) surgery. This study compared the efficacy and safety of low-density (LD) versus high-density (HD) pedicular screw implants in the correction of deformity in AIS regarding clinical, radiological, and quality of life outcomes. MethodsThis study was a single-blind, parallel, randomized trial that enrolled 20 adolescent patients with idiopathic scoliosis scheduled for posterior spinal fusion surgery with all pedicle screw constructs. Patients were randomized into two groups of 10 patients each. The LD group included patients in whom the number of screws per fused spinal level had a density of 1.5 or less, while the HD group had a density greater than 1.5. The primary outcomes were the radiological findings of curve correction. The secondary outcomes included the correlation between implant density and curve correction, the amount of blood loss, operation time, number of screws, fusion level, hospital stay duration, and quality of life assessed by the Scoliosis Research Society 22r questionnaire. ResultsRadiologically, the postoperative main curves Cobb angles and their changes were comparable between both approaches without statistical correlation with the implant density (p˃0.05). The LD approach significantly shortened the operative time (p=0.015), number of screws (p=0.011), implant density (p<0.001), and hospital stay (p<0.001). However, quality of life scores before surgery and at final follow-up did not differ between the two techniques (p˃0.05). ConclusionsThe use of a low-density approach is an effective and safe methodology for attaining satisfactory deformity correction in AIS patients. Furthermore, this approach confers the additional advantage of reduced operative time, number of screws, implant density, and hospital stay in comparison to the high-density approach.Trial registration Pan African Clinical Trial Registry, PACTR202404611444119. Registered 28 March 2024-Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=29382

Cranial sagittal vertical axis to the hip as the best sagittal alignment predictor of patient-reported outcomes at 2 years postoperatively in adult spinal deformity surgery.

The objective was to discern whether the cranial sagittal vertical axis (CrSVA) can best predict the trajectory of patient-reported outcome measures (PROMs) at 2 years postoperatively. This was a retrospective cohort study of prospectively collected adult spinal deformity patient data. CrSVA relative to the sacrum, hip (CrSVA-H), knee, and ankle was measured as the horizontal distance to the vertical plumb line from the nasion-inion midpoint, with positive values indicating an anterior cranium. Standard sagittal alignment parameters were also collected. Outcome variables were PROMs as measured by Scoliosis Research Society-22r questionnaire (SRS-22r) total and subdomain scores and the Oswestry Disability Index. Pearson's correlation coefficients and univariate regressions were performed to investigate associations between predictors and PROMs. Two conceptual multivariable linear regression models for each 2-year outcome measure were built after adjusting for the impact of preoperative SRS-22r scores. Model 1 assessed pre- and postoperative alignment only relative to C2 and C7, while model 2 assessed alignment relative to C2 and C7 as well as the cranium. There was a total of 363 patients with 2 years of radiographic and PROM follow-up (68.0% female, mean [standard error of the mean] age 60.8 [0.78] years, BMI 27.5 [0.29], and total number of instrumented levels 12.8 [0.22]). CrSVA measures were significantly associated with the 2-year SRS-22r total and subdomain scores. In univariate regression, revision surgery, number of prior surgeries, frailty, BMI, total number of osteotomies, and lower baseline total SRS-22r score as well as postoperative sagittal alignment were significantly associated with worse 2-year SRS-22r scores. In multivariable regression, after adjusting for baseline SRS-22r scores, greater preoperative C2 to sacrum sagittal vertical axis (SVA) and C7 SVA were found to be the only independent predictors of 2-year total SRS-22r score (β = -0.011 [p = 0.0026] and β = 0.009 [p = 0.0211], respectively) when alignment was considered only relative to C2. However, in the subsequent model, CrSVA-H replaced C7 SVA as the independent factor driving postoperative SRS-22r total scores (β = -0.006, p < 0.0001). That is, when the model included alignment relative to the cranium, C2, and C7, greater or more anterior CrSVA-H resulted in worse SRS-22r scores, while smaller or more posterior CrSVA-H resulted in better scores. Similar models for subdomains again found CrSVA-H to be the best predictor of function (β = -0.0095, p < 0.0001), pain (β = -0.0091, p < 0.0001), self-image (β = -0.0084, p = 0.0004), and mental health (β = -0.0059, p = 0.0026). In multivariable regression, C7 SVA was supplanted by CrSVA-H alignment as a significant, independent predictor of 2-year SRS-22r scores in patients with adult spinal deformity and should be considered as one of the standard postoperative sagittal alignment target goals.

Scoliosis Research Society-22r and Ceiling Effects: Limited Capabilities for Precision-Medicine with Adolescent Idiopathic Scoliosis.

Retrospective registry analysis. To examine predictions of individual Scoliosis Research Society-22r (SRS-22r) questions one year after surgery for adolescent idiopathic scoliosis (AIS). A precision-medicine approach to AIS surgery will inform patients of the likelihood of achieving particular results from surgery, specifically individual responses to the SRS-22r questionnaire. A multi-center AIS registry was queried for surgical AIS patients treated between 2002-2020. Preoperative data collected included standard demographic data, deformity descriptive data, and SRS-22r scores. Postoperative 1yr SRS-22r scores were modeled using ordinal logistic regression. . The highest probability was the most likely response. Model performance was examined by c-statistics, where c>.8 was considered excellent. Ceiling effects were measured by the proportion of patients reporting "5" to each question. 3251 patients contributed data to the study; mean age 14.4 (±2.2) yrs, female 2631 (81%), major thoracic coronal curve 53°, mean lumbar 41°. C-statistic values ranged from .6 (poor) to .8 (excellent) evidence of varied predictive capabilities. Q17 ("days off work/school", c = .84, ceiling achieved 75%) and Q15 ("financial difficulties", c = .86, ceiling achieved 82%) had the greatest predictive capabilities while Q11 ("pain medication", c=.73, ceiling achieved 67%), Q10 ("appearance", c=.72, ceiling achieved 35%), and Q19 ("attractive", c=.69, ceiling achieved 37%) performed poorly. Prediction of individual SRS-22r item responses perhaps most germane to AIS treatment was poor. Prediction of less relevant outcomes, where ceiling effects are present, was greater as the models chose "5" for all responses. These ceiling effects may limit discrimination and hamper efforts at personalized outcome predictions. 3.

Epigenetic age biomarkers and risk assessment in adult spinal deformity: a novel association of biological age with frailty and disability.

Surgery for spinal deformity has the potential to improve pain, disability, function, self-image, and mental health. These surgical procedures carry significant risk and require careful selection, optimization, and risk assessment. Epigenetic clocks are age estimation tools derived by measuring the methylation patterns of specific DNA regions. The study of biological age in the adult deformity population has the potential to shed insight onto the molecular basis of frailty and to improve current risk assessment tools. Adult patients who underwent deformity surgery were prospectively enrolled. Preoperative whole blood samples were used to assess epigenetic age and telomere length. DNA methylation patterns were quantified and processed to extract 4 principal component (PC)-based epigenetic age clocks (PC Horvath, PC Hannum, PC PhenoAge, and PC GrimAge) and the instantaneous pace of aging (DunedinPACE). Telomere length was assessed using both quantitative polymerase chain reaction (telomere to single gene [T/S] ratio) and a methylation-based telomere estimator (PC DNAmTL). Patient demographic and surgical data included age, BMI, American Society of Anesthesiologists Physical Status Classification System class, and scores on the Charlson Comorbidity Index, adult spinal deformity frailty index (ASD-FI), Edmonton Frail Scale (EFS), Oswestry Disability Index, and Scoliosis Research Society-22r questionnaire (SRS-22r). Medical or surgical complications within 90 days of surgery were collected. Spearman correlations and beta coefficients (β) from linear regression, adjusted for BMI and sex, were calculated. Eighty-three patients were enrolled with a mean age of 65 years, and 45 were women (54%). All patients underwent posterior fusion with a mean of 11 levels fused and 33 (40%) 3-column osteotomies were performed. Among the epigenetic clocks adjusted for BMI and sex, DunedinPACE showed a significant association with ASD-FI (β = 0.041, p = 0.002), EFS (β = 0.696, p = 0.026), and SRS-22r (β = 0.174, p = 0.013) scores. PC PhenoAge showed associations with ASD-FI (β = 0.029, p = 0.028) and SRS-22r (β = 0.159, p = 0.018) scores. PC GrimAge showed associations with ASD-FI (β = 0.029, p = 0.037) and SRS-22r (β = 0.161, p = 0.025) scores. Patients with postoperative complications were noted to have shorter telomere length (T/S 0.790 vs 0.858, p = 0.049), even when the analysis controlled for BMI and sex (OR = 1.71, 95% CI 1.07-2.87, p = 0.031). Epigenetic clocks showed significant associations with markers of frailty and disability, while patients with postoperative complications had shorter telomere length. These data suggest a potential role for aging biomarkers as components of surgical risk assessment. Integrating biological age into current risk calculators may improve their accuracy and provide valuable information for patients, surgeons, and payers.

Heath-related quality of life and functional outcomes in patients with congenital or juvenile idiopathic scoliosis after an average follow-up of 25 years: a cohort study

Background ContextCongenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce. PurposeTo evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up. Study DesignComparative cohort study. Patient SampleA consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation. Outcome MeasuresHRQoL (SF-36, SRS-22r, ODI). MethodsThe primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison. ResultsIn total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains. ConclusionsExcept for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.

Does spinal deformity affect adolescents' quality of life before we tell them it should?

The Scoliosis Research Society 22r Questionnaire(SRS-22r) is the standard for assessing health-related quality of life(HRQoL) in patients with adolescent idiopathic scoliosis. Here we investigate whether patients' perceptions of their HRQoL are influenced by knowledge of scoliosis and counseling by an orthopedic surgeon. Patients ages 10-18years referred for their first visit with an orthopaedic surgeon for scoliosis were enrolled from 9/30/19 to 10/22/20. Patients completed the SRS-22r pre- and post-visit. A Wilcoxon signed-rank test was used to analyze the SRS-22r scores. 52 patients participated in the study at a mean age of 14.3years (95% CI 13.8-14.8years) with an average major curve magnitude of 23.2 degrees (95% CI 19.4-27.0 degrees). SRS-22r scores were not correlated to curve magnitude pre- or post-visit. The SRS-22r Satisfaction with care domain exhibited a small increase from pre- to post-visit (pre: 3.3, post: 3.6). All other SRS-22r domains and total scores did not exhibit clinically significant differences. Among new adolescent referrals for scoliosis, it is unlikely that counseling by a surgeon influences perceptions of HRQoL as measured by the SRS-22r. III.

Health-related quality of life in adolescents with idiopathic scoliosis: a cross-sectional study including healthy controls.

To describe health-related quality of life in adolescents with idiopathic scoliosis and controls. This cross-sectional study analysed data from 307 individuals with idiopathic scoliosis and 80 controls without scoliosis (mean age 15.5 ± 2.1 and 14.0 ± 2.2years, respectively). Health-related quality of life (HRQoL) was assessed using EuroQol 5-dimensions (EQ-5D) questionnaire, and the scoliosis specific Scoliosis Research Society-22r questionnaire (SRS-22r). HRQoL data in individuals with scoliosis were compared to controls, between treatment groups (untreated, ongoing brace, previously braced and surgically treated) and stratified according to curve size. Adolescents with idiopathic scoliosis had reduced HRQoL compared with controls, observed through lower SRS-22r subscore (respective means 4.16 and 4.68, p < 0.001) and lower EQ-5D index (respective means 0.92 and 0.95, p = 0.032). No differences in SRS-22r subscore or EQ-5D index were detected when comparing different scoliosis treatment groups. Within the SRS-22r function domain the surgically treated group scored 4.40, significantly lower compared to the untreated (4.65) and ongoing brace groups (4.68, p = 0.005). The surgically treated and untreated group were more affected by pain, compared to the ongoing brace group (p = 0.01) with the surgically treated group scoring lowest. Non-surgically treated scoliosis individuals with larger curves (> 30 degrees) had a lower SRS-22r subscore (4.08) compared to those with smaller curves (4.31, p = 0.001). Adolescents with idiopathic scoliosis had a reduced HRQoL compared to healthy controls. Minor differences were detected when comparing between idiopathic scoliosis treatment groups. Non-surgically treated scoliosis patients with larger curves had a lower HRQoL shown by lower SRS-22r values.

P25. A rough road to recovery: the impact of complications after adult spinal deformity surgery on specific health-related quality of life domains

BACKGROUND CONTEXT Previous reports indicate postoperative complications have minimal impact on long-term outcomes after ASD surgery. Little data has evaluated the impact of complications on specific heath domains during postoperative period. PURPOSE To evaluate the impact of specific complications on patient reported health domains compared to patients with no complications. STUDY DESIGN/SETTING Prospective, multicenter, propensity score matched analysis. PATIENT SAMPLE ASD patients enrolled into a prospective multi-center study. OUTCOME MEASURES Oswestry Disability Index, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), postoperative complications. METHODS Surgically treated ASD patients enrolled into a multicenter study were assessed for postoperative complications requiring surgery including wound (WOUND), pseudoarthrosis (PSEUDO), neurologic (NEURO) and malalignment (MAL) and matched to patients with no complications (NOCOMP) using inverse probability weighting for demographic, radiographic and surgical variables. Health domains for SRS-22r, and SF-36 were evaluated at regular time intervals, domain scores normalized to the date of revision surgery, and compared to patients with no complications at minimum 2-year follow-up. RESULTS A total of 566 of 1130 were analyzed, average 3.6 yrs (range: 1.9 to 9). WOUND (n=12) compared to NOCOMP (n=390) had worse SF-36 physical function(21.7 vs 27.4), social function(19.6 vs 28.9), general health (-7.3 vs 8.9) and vitality (-0.9 vs 26.6,p < 0.05). PSEUDO (n=64) was worse than NOCOMP for SRS-22r function, 1.4 vs 2.1, and SF-36 social function, (17.1 vs 28.9) (p < 0.05). NEURO (n=28) was worse than NOCOMP for SRS-22r (0.9 vs 2.1), SF-36 bodily pain (14.7 vs 35.7) and social function (13.4 vs 28.9) (p < 0.05). MAL (n=72) was worse than NOCOMP for SRS-22r pain, (2.7 vs 3.4), function (1.2 vs 2.1), self-image (3.0 vs 3.9), SF-36 bodily pain (27.6 vs 35.7), physical function (18.7 vs 27.4), and social function (11.6 vs 28.9) (p < 0.05). CONCLUSIONS Counter to previous reports, specific postoperative complications requiring surgery uniquely impact specific health domains, resulting in worse patient reported quality of life compared to ASD patients with no complications. Social function was negatively impacted for all complications, while wound complications negatively impacted patient perceived general health and vitality and patients with malalignment requiring surgery reported worse self-image. These data highlight new findings that postoperative complications have a negative impact on specific aspects of ASD quality of life that can undermine the potential benefits of ASD surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Previous reports indicate postoperative complications have minimal impact on long-term outcomes after ASD surgery. Little data has evaluated the impact of complications on specific heath domains during postoperative period. To evaluate the impact of specific complications on patient reported health domains compared to patients with no complications. Prospective, multicenter, propensity score matched analysis. ASD patients enrolled into a prospective multi-center study. Oswestry Disability Index, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), postoperative complications. Surgically treated ASD patients enrolled into a multicenter study were assessed for postoperative complications requiring surgery including wound (WOUND), pseudoarthrosis (PSEUDO), neurologic (NEURO) and malalignment (MAL) and matched to patients with no complications (NOCOMP) using inverse probability weighting for demographic, radiographic and surgical variables. Health domains for SRS-22r, and SF-36 were evaluated at regular time intervals, domain scores normalized to the date of revision surgery, and compared to patients with no complications at minimum 2-year follow-up. A total of 566 of 1130 were analyzed, average 3.6 yrs (range: 1.9 to 9). WOUND (n=12) compared to NOCOMP (n=390) had worse SF-36 physical function(21.7 vs 27.4), social function(19.6 vs 28.9), general health (-7.3 vs 8.9) and vitality (-0.9 vs 26.6,p < 0.05). PSEUDO (n=64) was worse than NOCOMP for SRS-22r function, 1.4 vs 2.1, and SF-36 social function, (17.1 vs 28.9) (p < 0.05). NEURO (n=28) was worse than NOCOMP for SRS-22r (0.9 vs 2.1), SF-36 bodily pain (14.7 vs 35.7) and social function (13.4 vs 28.9) (p < 0.05). MAL (n=72) was worse than NOCOMP for SRS-22r pain, (2.7 vs 3.4), function (1.2 vs 2.1), self-image (3.0 vs 3.9), SF-36 bodily pain (27.6 vs 35.7), physical function (18.7 vs 27.4), and social function (11.6 vs 28.9) (p < 0.05). Counter to previous reports, specific postoperative complications requiring surgery uniquely impact specific health domains, resulting in worse patient reported quality of life compared to ASD patients with no complications. Social function was negatively impacted for all complications, while wound complications negatively impacted patient perceived general health and vitality and patients with malalignment requiring surgery reported worse self-image. These data highlight new findings that postoperative complications have a negative impact on specific aspects of ASD quality of life that can undermine the potential benefits of ASD surgery.

55. Bone morphogenetic protein (BMP) use in adult spinal deformity surgery is associated with reduced implant failures and lower cost/QALY at mean four years postoperative

<h3>BACKGROUND CONTEXT</h3> Despite studies reporting the efficacy of BMP to promote surgical spinal fusion, hospital systems and third-party payors continue to deny use of BMP, claiming high cost and lack of long term follow up. <h3>PURPOSE</h3> Perform a propensity score matched analysis of complications and cost-effectiveness for surgically treated adult spinal deformity (ASD) patients receiving BMP vs no BMP. <h3>STUDY DESIGN/SETTING</h3> Prospective, multicenter, propensity score matched analysis. <h3>PATIENT SAMPLE</h3> ASD patients enrolled into a prospective multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), cost of care, cost/QALY, postoperative complications. <h3>METHODS</h3> Surgically treated ASD patients prospectively enrolled into a multicenter study from 2009-2018 were assessed for receiving BMP or NOBMP (iliac crest bone graft and allograft only) at the time of surgery. BMP and NOBMP cohorts were propensity score matched (PSM) for age, BMI, frailty, total levels fused, fusion to the pelvis, osteotomies, interbody fusion and supplemental rod use. Postoperative alignment, complications, rod fractures, patient-reported outcomes (PROMs), cost of care (based on DRG reimbursements adjusted to 2021 US dollars), were evaluated at minimum 3-year follow-up, and cost/QALY calculated at 1-,2-, and minimum 3-year follow-up. <h3>RESULTS</h3> Of 888 patients, 483 (mean 4.2 years follow-up, range 2.9 to 8.8) were evaluated. Mean BMP dosage was 27.6 mg total (range 1 to 200), 2.2 mg/level posterior (range 0 to 25) and 1.7 mg/level interbody (range 0 to 18). BMP (n=407) had similar demographics, osteotomies, total and interbody levels fused, preop PROMs, follow-up duration, and pre- and postoperative spinal alignment as NOBMP (n=76; p>0.05). BMP had fewer implant failures (0.17/patient vs 0.33/patient; p 0.05). At last follow-up, BMP had better SF-36 social function (46.7 vs 43.9) and SF-36 mental component scores (51.5. vs 47.8) than NOBMP (p <0.05, respectively). BMP had lower mean total cost of care/patient ($78,679.61 vs $103,388.78) and lower cost/QALY ($22,455.48 vs $32,947.68) at last follow-up vs NOBMP, respectively (p < 0.05). Revision surgery rates were similar for BMP vs NOBMP (0.32 vs 0.42/patient, p=0.11); however, costs of revision surgery were less for BMP ($11,114.33) vs NOBMP ($22,912.53, p <0.05). <h3>CONCLUSIONS</h3> Propensity score matched analysis demonstrated BMP use in ASD surgery at mean 4-year follow-up was associated with decreased implant fracture rates, lower treatment costs and better cost/QALY than NOBMP. Hospital systems, administrators and third-party payors should consider that the initial cost of BMP use at index surgery may be offset by decreased total cost of care and improve cost/QALY for ASD patients. <h3>FDA DEVICE/DRUG STATUS</h3> Bone morphogenetic protein: Investigational.

56. Predictive models identify patient and surgical variables that synergistically produce an optimal outcome following adult spine deformity (ASD) surgery

<h3>BACKGROUND CONTEXT</h3> Identifying the components needed for an optimal adult spinal deformity (ASD) surgical outcome could help inform surgeons and improve ASD treatment. However, defining the components that create an optimal outcome for ASD surgery is challenging because outcome metrics depend on multiple perspectives. A patient may receive a technically successful complication-free surgery but may report dissatisfaction with the treatment outcome. Conversely, a patient may incur multiple postoperative complications with high societal cost but report satisfaction with the surgical outcome. <h3>PURPOSE</h3> (1) Define an "optimal" ASD surgical outcome by integrating outcome metrics from multiple perspectives, and (2) identify the patient-specific and surgical components of ASD treatment that surgeons can employ to improve ASD surgery by creating a model that predicts a multi-perspective "optimal" surgical outcome. <h3>STUDY DESIGN/SETTING</h3> Prospective, multicenter analysis. <h3>PATIENT SAMPLE</h3> ASD patients enrolled into a prospective multicenter study. <h3>OUTCOME MEASURES</h3> Scoliosis Research Society-22r questionnaire (SRS-22r), Oswestry Disability Index (ODI), postoperative complications. <h3>METHODS</h3> Surgically treated ASD patients prospectively enrolled into a multicenter study from 2009-2018 were assessed at minimum 2-year follow-up for optimal outcome defined as (1) no major postoperative complication or complication requiring surgery, (2) patient reached MCID for ODI and SRS-22r subscore, and (3) patient satisfied and indicates would have the surgery again. Demographic, radiographic, PROM and surgical variables were assessed for associations with optimal outcome. Multivariate regression models were built based on level of upper instrumented vertebra (UIV) to identify variables that created a best fit predictive model for optimal outcome by R2 maximization and AIC/BIC minimization. <h3>RESULTS</h3> Of 1291 patients, 788 (mean 3.5 years follow-up), were eligible for study and evaluated. Optimal outcome patients (OP; n=196) had less preoperative opioid use (47.5% vs 56.8%) and fewer histories of prior spine surgery (65.4% vs 77.3%) than nonoptimal outcome (NO; n=592), respectively (p 0.05). Creation of the best fit predictive model for optimal outcome demonstrated synergy between several modifiable variables including preoperative BMI and opioid and tobacco use, final SVA and scoliosis, and use of supplemental rods and PJF prophylaxis. Refining the model for specific surgeries based upon UIV demonstrated increased synergistic impact of the modifiable variables and predictive accuracy (thoracolumbar UIV R2=0.41; upper thoracic UIV R2=0.77). <h3>CONCLUSIONS</h3> No single surgical or radiographic variable is independently predictive of an a priori defined multiperspective optimal outcome following ASD surgery. However, predictive modeling identified preoperative BMI, opioid and tobacco use, final SVA and scoliosis, and use of supplemental rods and PJF prophylaxis as variables surgeons can optimize and/or employ that act synergistically to predict an optimal ASD surgical outcome. Future research will focus on development of predictive models that highlight the synergistic effects of patient specific and interventional variables to improve surgical outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Construct Validity of Pediatric PROMIS Computerized Adaptive Testing Measures in Children With Adolescent Idiopathic Scoliosis.

The use of patient-reported outcome measures, especially Patient-Reported Outcomes Measurement Information System (PROMIS) measures, has increased in recent years. Given this growth, it is imperative to ensure that the measures being used are validated for the intended population(s)/disease(s). Our objective was to assess the construct validity of 8 PROMIS computer adaptive testing (CAT) measures among children with adolescent idiopathic scoliosis (AIS). We prospectively enrolled 200 children (aged 10 to 17 y) with AIS, who completed 8 PROMIS CATs (Anxiety, Depressive Symptoms, Mobility, Pain Behavior, Pain Interference, Peer Relationships, Physical Activity, Physical Stress Experiences) and the Scoliosis Research Society-22r questionnaire (SRS-22r) electronically. Treatment categories were observation, bracing, indicated for surgery, or postoperative from posterior spinal fusion. Construct validity was evaluated using known group analysis and convergent and discriminant validity analyses. Analysis of variance was used to identify differences in PROMIS T -scores by treatment category (known groups). The Spearman rank correlation coefficient ( rs ) was calculated between corresponding PROMIS and SRS-22r domains (convergent) and between unrelated PROMIS domains (discriminant). Floor/ceiling effects were calculated. Among treatment categories, significant differences were found in PROMIS Mobility, Pain Behavior, Pain Interference, and Physical Stress Experiences and in all SRS-22r domains ( P <0.05) except Mental Health ( P =0.15). SRS-22r Pain was strongly correlated with PROMIS Pain Interference ( rs =-0.72) and Pain Behavior ( rs =-0.71) and moderately correlated with Physical Stress Experiences ( rs =-0.57). SRS-22r Mental Health was strongly correlated with PROMIS Depressive Symptoms ( rs =-0.72) and moderately correlated with Anxiety ( rs =-0.62). SRS-22r Function was moderately correlated with PROMIS Mobility ( rs =0.64) and weakly correlated with Physical Activity ( rs =0.34). SRS-22r Self-Image was weakly correlated with PROMIS Peer Relationships ( rs =0.33). All unrelated PROMIS CATs were weakly correlated (| rs |<0.40). PROMIS Anxiety, Mobility, Pain Behavior, and Pain Interference and SRS-22r Function, Pain, and Satisfaction displayed ceiling effects. Evidence supports the construct validity of 6 PROMIS CATs in evaluating AIS patients. Ceiling effects should be considered when using specific PROMIS CATs. Level II, prognostic.

Subjective perception of spinal deformity after selective versus non-selective fusion of Lenke 1C curves

PurposeTo assess the self-image perception and the Quality-of-Life (QoL) in female adolescents, with Lenke 1C scoliosis curves, treated with selective versus non-selective posterior spinal instrumentation and fusion (PSF).MethodsPatients undergoing PSF for idiopathic adolescent scoliosis (AIS) were recruited and divided into two groups: patients managed with selective thoracic fusion (STF) were included in Group A, whereas patients treated with non-selective fusion (N-STF) in Group B. Each patient completed the Italian version of the Scoliosis Research Society-22R questionnaire (SRS-22R), the Quality-of-Life Profile for Spinal Deformities questionnaire (QLPSD) and the Spinal Appearance Questionnaire (SAQ), before surgery and at 24-month follow-up.ResultsOne hundred and fifty seven female patients (mean age 16.38) were included in this study. 80 patients underwent STF, while 77 patients received N-STF. At 24-month follow-up, patients managed with N-STF showed better SRS-22R self-image mean score (p = .012), SRS-22R satisfaction mean score (p = .033), QLPSD body image mean score (p = .005), but worse SRS-22 function mean score (p = .006) and QLPSD back flexibility mean score (p = .007), compared with patients who underwent STF. In terms of self-image perception, patients undergoing STF showed significantly worse SAQ total mean score (p = .002), SAQ appearance mean score (p = .001) and SAQ expectation (p = .001). We found a significant correlation between SAQ appearance mean score and SRS-22R self-image (R = − 0.721), SRS-22 mental health (R = − 0.8), QLPSD psychosocial functioning (R = 0.7) and QLPSD back flexibility (R = 0.8).ConclusionAlthough the STF of Lenke 1C curves provides better functional outcomes, in the present study, female patients receiving STF revealed a worse perceived body image, compared with patients treated with N-STF, at 24-month follow-up. Particular attention should be addressed to the preoperative patient’s mental health and body image perception, when choosing between STF and N-STF.

172. Matched analysis demonstrates fusion to upper thoracic spine does not improve correction or outcomes compared to thoracolumbar upper instrumented vertebra (UIV) for select adult spinal deformities

172. Matched analysis demonstrates fusion to upper thoracic spine does not improve correction or outcomes compared to thoracolumbar upper instrumented vertebra (UIV) for select adult spinal deformities

177. Would you do it again? Discrepancies between patient and surgeon willingness for adult spine deformity surgery

<h3>BACKGROUND CONTEXT</h3> ASD surgery is associated with postoperative improvements in patient pain and function but is also associated with high complication rates and long recovery. Accordingly, if given a choice, patients may indicate they would not undergo surgery again. <h3>PURPOSE</h3> At minimum two years postop, evaluate 1) surgically treated ASD patients for willingness to receive/not receive the same surgery, 2) surgeon willingness to perform/not perform the same surgery, 3) surgeon opinion if the corresponding patient would indicate they would/would not have the same surgery again. <h3>STUDY DESIGN/SETTING</h3> Analysis of patient vs surgeon willingness to perform/receive surgery for ASD patients enrolled into a prospective, multicenter study. <h3>PATIENT SAMPLE</h3> Surgically treated ASD patients prospectively enrolled into multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), estimated blood loss, duration of hospital stay, postoperative complications, revision spine surgery, patient and surgeon willingness to perform surgery. <h3>Methods</h3> Surgically treated ASD patients, prospectively enrolled into a multicenter study from 2009-2018, were asked at minimum 2 years postop, using SRS-22r question 22 if, based upon their surgical and recovery experience, they would undergo the same surgery. Surgeons were matched to their corresponding patients and the surgeons asked if 1) surgeon would perform the same surgery on the patient and why/why not, 2) surgeon believed the patient would undergo the same surgery and why/why not. Patients were divided into those that indicated they would (yes) or not (no) have same surgery. Agreement between patient and surgeon willingness for same surgery was assessed and correlations between willingness for same surgery and postop complications, deformity improvement, and PROMs evaluated. <h3>Results</h3> Of 961 patients eligible for study, 580 were evaluated. The no group (n=108, 18.6%) had similar levels fused, osteotomies, duration of hospital and SICU stay, and major complications as the yes group. (n=472; 81.4%; p>0.05). No group members were younger (58.5 vs 61.6 years), more frail (ASD frailty scale 3.9 vs 3.3), and at minimum 2-years postop had more complications requiring surgery and worse postop improvements for all PROMs including ODI (3.8 vs 18.9), SF-36 PCS (1.8 vs 10) and SRS-22r total (0.4 vs 0.9), pain (0.5 vs 1.2), activity (0.2 vs0.7), and self-image (0.6 vs 1.3) than the yes group, respectively (p<0.05). MCID was reached in 28-56% of no group vs 62- 81% of yes group. Patient willingness to receive surgery varied by surgical institution (70% to 89%; p<0.05). Surgeons accurately identified yes group (91%) but poorly identified the no group (22%; p<0.05). <h3>Conclusions</h3> ASD patient willingness to undergo same surgery is important for counseling. Unwillingness for same surgery was associated with PROMs, MCID and complications requiring surgery. Surgeons were poorly able to identify patients unwilling to undergo the same surgery. More research is needed to understand patient experiences recovering from ASD surgeries. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P94. Preoperative opioid use poorly correlates with mental health in adult spinal deformity: Time to rethink foregone conclusions

<h3>BACKGROUND CONTEXT</h3> Preoperative opioid consumption, poor mental health, and lower socioeconomic status are each associated with worse surgical outcomes for adult spinal deformity (ASD). Little data exits evaluating preoperative morphine milligram equivalent (MME) consumption and preoperative mental health, social function, and socioeconomic status in ASD. <h3>PURPOSE</h3> Evaluate the correlations between preoperative daily MME consumption and preoperative depression, anxiety, mental health scores, and socioeconomic status for ASD patients prior to receiving reconstructive ASD surgery. We hypothesized that preoperative MME consumption correlates with preoperative depression, anxiety, poor mental health, poor social function, and poor socioeconomic status in ASD. <h3>STUDY DESIGN/SETTING</h3> Preoperative analysis of ASD patients prospectively enrolled into a multicenter study. <h3>PATIENT SAMPLE</h3> ASD patients prospectively enrolled into multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Edmonton Frailty Index (EFI score), grip strength, Veterans Rand Health Questionnaire (VR-12), Oswestry Disability Index (ODI), daily morphine milligram equivalent consumption (MME), PROMIS-Pain Interference (PROMIS-PI), PROMIS-Physical Function (PROMIS-PF), PROMIS-Depression (DEP), PROMIS-Anxiety (ANX), PROMIS-Satisfaction with Social Roles (SR) and PROMIS-Satisfaction with Discretionary Social Activities (SDA) computer adaptive tests (CATs), Area Deprivation Index (ADI) scores. <h3>METHODS</h3> From 2018-2020, ASD patients were prospectively enrolled into a multicenter study. Preoperative MME was calculated. Preoperative PROMIS-DEP, PROMIS-ANX, PROMIS=SR, PROMIS-SDA, PROMIS-PI and PF, SRS-22r total and domain scores, and VR-12 mental component summary (MCS) were calculated. ADI scores were collected to assess socioeconomic status, as previously described. MME data were log transformed and two-tailed Pearson correlation coefficients calculated. Correlation strengths were interpreted according to Cohen. Confidence intervals were created with 1,000 sample bootstrapping. <h3>RESULTS</h3> A total of 207/207 patients enrolled were evaluated; mean age 61 years (18-81). Preoperative opioid consumption was reported in 38% patients (n=78; mean preoperative MME 22.5 mg, range 1-420 mg). Preoperative MME did not correlate with PROMIS-ANX (p=0.07) and did not correlate with socioeconomic status (ADI; p=0.37). Preoperative MME showed small correlations with PROMIS-DEP (r=0.2, p=0.01), VR-12 MCS (r=-.2, p=0.002), and SRS-Mental Health (r=-0.2, p=0.005). Preoperative MME showed moderate correlations with PROMIS-PI (r=0.4, p<0.0001), PROMIS-PF (r=-0.4, p<0.0001), SRS-Pain (r=-0.5, p<0.0001), SRS-Function (r=-0.4, p<0.0001), PROMIS-SR (r=-0.3, p<0.0001) and PROMIS-SSA (r=-0.4, p<0.0001). <h3>CONCLUSIONS</h3> Prospective evaluation of 207 ASD patients demonstrated minimal to no correlations between preoperative MME consumption and preoperative anxiety, depression or low socioeconomic status. Preoperative MME consumption demonstrated moderate correlations with preoperative pain, physical function, and social function scores. The negative impacts of opioid consumption on physical measures are likely independent of psychosocial variables in ASD. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

188. Prospective analysis of adult spinal deformity patients demonstrates radically different preop demographic, radiographic and quality of life parameters for primary vs revision patients

<h3>BACKGROUND CONTEXT</h3> ASD is a vague and heterogeneous label applied to adults afflicted with varying types, severities, and etiologies of spine deformities. We hypothesized that ASD patients with a history of spine fusion and associated spine deformity (revision=R) have distinct pathognomonic differences from ASD patients with no history of spine fusion (primary=P). <h3>PURPOSE</h3> Evaluate baseline differences for revision vs primary ASD patients including demographics, radiographic spine deformity, functional measures, opiate consumption and patient-reported outcome measures (PROMs), prior to receiving reconstructive ASD surgery. <h3>STUDY DESIGN/SETTING</h3> Preoperative analysis of ASD patients prospectively enrolled into a multicenter study. <h3>PATIENT SAMPLE</h3> ASD patients prospectively enrolled into multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Edmonton Frailty Index (EFI score), grip strength, Veterans Rand Health Questionnaire (VR-12), Oswestry Disability Index (ODI), daily morphine milligram equivalent consumption (MME), PROMIS-Pain Interference (PROMIS-PI), PROMIS-Physical Function (PROMIS-PF), PROMIS-Depression (DEP), PROMIS-Anxiety (ANX), PROMIS-Satisfaction with Social Roles (SR) and PROMIS-Satisfaction with Discretionary Social Activities (SSA) computer adaptive tests (CATs). <h3>METHODS</h3> From 2018-2020, patients age >18 years were enrolled in a multicenter prospective study evaluating surgical treatment for ASD. Patients were dichotomized according to R vs P, and preop demographics, grip strength, frailty, daily MME consumption, physical examination, radiographic measures, and PROMs data were compared. <h3>RESULTS</h3> A total of 204/204 enrolled patients were evaluated; R (n=99), P (n= 105). R and P had similar age, Charleson Comorbidity Index (CCI) and gender distribution (p>0.05). R had greater daily MME consumption (35mg vs 15mg), were more frail (EFI score 4 vs 2), and had greater incidence of motor deficits (54% vs 37%) than P, respectively (p<0.05). R differed radiographically from P in 11/15 measurements, as nearly all sagittal parameters were worse for R (SVA=139mm vs 57mm; PI-LL=26° vs 12°; PT=28.2° vs 20.7°), while P had greater scoliosis (50.6° vs 20.3°), respectively (p<0.05). Nearly all PROM measures were worse for R vs P, including disability (ODI=48 vs 38), pain measures (PROMIS PI=66.9 vs 61.9; NRS-Back=7.0 vs 6.0), physical function (PROMIS-PF=32.8 vs 36.8, SRS-Activity=2.6 vs 3.2), social function (PROMIS-SSA= 40.4 vs 45.4), depression (PROMIS-DEP=51.1 vs 48.8), and self-image (SRS-Appearance=2.2 vs 2.6). <h3>CONCLUSIONS</h3> Revision ASD patients are distinctly different from primary ASD patients. Despite having similar preop age, gender and CCI, R were more frail, consumed more opiates, and reported greater pain, disability, function, and worse mental health than P. R had greater sagittal deformities while P had worse coronal deformities. Future analysis of ASD patients should distinguish between revision and primary patients to avoid confounding analyses. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

212. Matched analysis demonstrates acute rehabilitation or skilled nursing facility care does not reduce readmissions, return to surgery or improve outcomes compared to home discharge following adult spine deformity surgery

<h3>BACKGROUND CONTEXT</h3> Concerns exist regarding disease transmission and cost associated with postoperative nonroutine discharge. Few data exist evaluating impact of nonroutine vs home discharge on readmissions, complications and patient reported outcome measures (PROMs) for adult spinal deformity (ASD) surgery. <h3>PURPOSE</h3> Evaluate 30-day readmissions, 90-day return to surgery, postoperative complications, and postoperative PROMs for matched ASD patients receiving nonroutine discharge vs home discharge following surgery. <h3>STUDY DESIGN/SETTING</h3> Propensity score matched (PSM) analysis of ASD patients prospectively enrolled into a multicenter study. <h3>PATIENT SAMPLE</h3> Surgically treated ASD patients prospectively enrolled into multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), duration of hospital stay, 30-day readmission, 90-day return to surgery, postoperative complications. <h3>METHODS</h3> Surgically treated ASD patients prospectively enrolled in a multicenter ASD study were divided into two discharge disposition groups, nonroutine (NON) and home (HOME). NON was further divided into acute rehab (REHAB) or skilled nursing facility (SNF) discharge. Study inclusion criteria; (1) surgery ≥5 levels fused, (2) ≥2-year follow-up. PSM was used to match NON vs HOME for age, frailty and total levels fused. 30-day hospital readmission, 90-day return to surgery, postoperative complications, one and minimum 2 year PROM data was compared for NON vs HOME, and REHAB vs SNF vs HOME. <h3>RESULTS</h3> From 2015 to 2019, 241 of 374 eligible treated patients were evaluated and 158 included in this study after PSM (mean 2.7 year follow-up). NON (n=106) and HOME (n=52) had similar age (67.6 vs 67.6 years), ASD-frailty index (3.9 vs 3.9), levels fused at surgery (13.8 vs 13.7), and preop PROMs, respectively (p>0.05). Duration of hospital stay (9.7 vs 10.4 days), 30-day readmission (6.6% vs 6.6%), 90-day return to surgery (9.4% vs10.4%), total complications/patient (2.0 vs 1.5), major complications/patient (0.8 vs 0.5), were similar NON vs HOME, respectively (p>0.05). At last follow-up, HOME demonstrated better ODI (21.6 vs 28.2), SRS-total (3.8 vs 3.5), and SRS-activity (3.7 vs 3.3) than NON, respectively (p<0.05). Sub-analysis of REHAB (N=63) vs SNF (N=41) vs HOME showed similar findings, including similar 30-day readmissions, 90-day return to surgery, and complications (p>0.05) and improved PROMs for HOME vs REHAB and SNF (p<0.05). <h3>CONCLUSIONS</h3> Analysis of 158 operatively treated ASD patients prospectively enrolled into a multicenter study and matched for age, frailty, and surgery performed demonstrated that postoperative discharge to skilled nursing or acute rehab facilities did not reduce 30-day readmissions, 90-day return to surgery, or postoperative complications. At one and minimum two years postop, patients discharged home had better PROMs scores than nonroutine discharge. These data should be considered in conjunction with postoperative needs and the cost and disease transmission risks for nonroutine discharge. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

51. Upper thoracic fusion does not impact physical function greater for younger vs older ASD patients undergoing long fusion to the pelvis

<h3>BACKGROUND CONTEXT</h3> Surgeons may preferentially limit fusion levels for younger vs older ASD patients to maintain motion segments and optimize postoperative function. Few data exist comparing the functional impact of upper thoracic (UT) vs thoracolumbar (TL) upper instrumented vertebra (UIV) in younger vs older ASD patients undergoing long fusion to the pelvis. <h3>PURPOSE</h3> Evaluate patient reported functional impact of UT vs TL UIV in younger vs older ASD patients undergoing long fusion to the pelvis. <h3>STUDY DESIGN/SETTING</h3> Propensity score matched (PSM) analysis of ASD patients prospectively enrolled into a multicenter study. <h3>PATIENT SAMPLE</h3> Surgically treated ASD patients prospectively enrolled into multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), estimated blood loss, duration of hospital stay, postoperative complications, revision spine surgery. <h3>METHODS</h3> Surgically treated ASD patients prospectively enrolled into a multicenter ASD study were divided into 2 age groups (younger= <65 years, older=> 65 years) and separated according to UIV (TL= L2-T7; UT=T6-T1). Study inclusion criteria; 1) surgery for Lumbar (L), Sagittal (S), or Mixed (M) deformities (as per SRS-Schwab ASD classification), 2) fusion to the pelvis, 3) minimum 5 levels fused, and 4) minimum 2 year postop follow up. Surgery for double major or thoracic scoliosis were excluded. PSM was used to match preop patient demographics, scoliosis, and sagittal spinopelvic parameters including PI-LL, TK, SVS, and TPA. Surgical data evaluated and impact of UIV upon patient reported functional outcomes compared for UT vs TL for younger vs older. <h3>RESULTS</h3> From 2008-2018, 435 of 717 eligible surgically treated patients were evaluated; younger (n=193; mean age 57.6 years) and older (n=242; mean age 72.3 years), mean levels fused UT=17.4, TL=10.7 (p<0.05). Preop spine deformity, demographics, and performance of osteotomies were similar for matched UT vs TL in younger and older (p>0.05). Surgical blood loss, duration of SICU and hospital stay was greater for UT vs TL in younger and older (p<0.05). UT had more revision surgery than TL due to implant failures in younger (20% vs 3%) and older (16% vs 1%), respectively (p<0.05). Older UT had more major complications than older TL (65% vs 30%). At minimum 2 year postoperative follow up spine deformity correction and all PROMs (including improvements and final values) including SRS-22r activity, SF-36 physical function, SF-36 role physical, SF-36 social function and SF-36 vitality were similar UT vs TL in younger and older (p>0.05). <h3>CONCLUSIONS</h3> Younger ASD patients fused to the pelvis do not report more physical restrictions for UT vs TL UIV compared to older ASD patients, however blood loss, SICU and hospital stay and complications were greater for UT vs TL in younger and older cohorts. When deciding upon UIV for ASD patients, the minimal impact of UT vs TL UIV upon patient reported outcomes must be offset by cognizance of a longer hospital stay and potential for greater postoperative complications for UT fusions especially in older patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

216. Contrary to popular belief, self-image in adult spinal deformity (ASD) is most correlated with physical and social function and mental health and minimally correlated with magnitude of spine deformity

BACKGROUND CONTEXT Self-image (SI) is the most negatively impacted health domain for ASD. SI also strongly correlates with ASD postoperative satisfaction. Surgeons often assume that negative SI is due to scoliosis and/or sagittal malalignment, however data from cancer patients indicates physical and social function is strongly associated with of self-image. Little data exists investigating SI in ASD. PURPOSE Evaluate the radiographic, demographic, and health related quality of life (HRQOL) variables most correlated with SI in operatively treated ASD patients. STUDY DESIGN/SETTING Regression analysis of radiographic, demographic and HRQOL domains most associated with baseline and postoperative improvements in SI for operatively treated ASD patients from a prospective multicenter database. PATIENT SAMPLE Surgically treated ASD patients enrolled into a prospective multicenter study of operative vs nonoperative treatment for ASD, minimum 2-year postoperative follow-up. OUTCOME MEASURES Numeric rating scale (NRS) for back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), self-image domain of SRS-22r. METHODS Baseline SI was assessed for operatively treated patients enrolled into a prospective multicenter study of operative vs nonoperative treatment for ASD (inclusion criteria age >18 years, scoliosis > 20°, thoracic kyphosis >60°, and/or SVA>5cm). Patients were organized according to SRS-Schwab ASD deformity types, and SI was reevaluated at minimum 2-year follow up. Regression analysis was performed on patient demographic, radiographic, and HRQOL domains and correlated with SI and treatment satisfaction. RESULTS A total of 591 of 789 patients eligible for study were evaluated (mean follow-up 3.2 years). Regression analysis demonstrated baseline SI (mean=2.4, range 1-4.6) correlated significantly (p 0.05). SI correlated most with SRS-22r activity (R=0.57), SF-36 social function (R=0.56), ODI (R=-0.52), SRS-22r mental health (R=0.51), and SF-36 vitality (R=0.50) but weakly with back (R=-0.265) and leg pain (R=-0.170; p 0.05). At last follow up SI improved from preop (3.6, range 1.6-5), and correlated most with improvements in SRS-22r activity (R=0.53), ODI (R=-0.45), and SRS-22r mental health (R=0.45; p CONCLUSIONS Baseline SI and postoperative SI improvement for ASD correlated most with physical and social function and mental health. ASD treatment satisfaction at 2 years postoperative strongly correlated with SI. The correlations between SI and physical and social function were independent of pain and spine deformity magnitude as correlations between SI, pain scales, scoliosis and sagittal malalignment ranged from weak to nonsignificant. These findings are consistent with research surrounding SI and cancer patients. More research is needed regarding the psychology and physiology of SI for ASD to improve patient outcomes and treatment satisfaction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

38. Opioid use prior to adult spine deformity (ASD) surgery worsens postoperative outcomes and risks continued postoperative use, independent of spine deformity magnitude and type of surgery performed: a propensity matched cohort analysis

BACKGROUND CONTEXT Opioid use prior to spine deformity surgery may compromise postoperative outcomes. However, patient comorbidities, deformity magnitude, and type of surgery performed are also associated with patient outcomes for ASD. An analysis to control for confounding variables including patient demographics and type of surgery performed may provide greater understanding of the impact that preoperative opioid use has on surgically treated ASD patients. PURPOSE Isolate the impact of preoperative opioid use on baseline and postoperative outcomes for ASD by performing a propensity score matched (PSM) analysis to control for confounding patient demographic, spine deformity, and surgical variables. STUDY DESIGN/SETTING Propensity score matched (PSM) analysis of operatively treated ASD patients from a prospective multicenter database. PATIENT SAMPLE ASD patients, age >18 years, no history of spine surgery prior to study enrollment, ≥4 levels fused at the time of surgery after study enrollment, and minimum 2 years of postoperative follow-up. OUTCOME MEASURES Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), duration of hospital stay, duration of ICU stay. METHODS ASD patients (age >18 years) enrolled into a prospective multicenter ASD database were divided into preoperative opioid (OPIOID) vs nonopioid (NON) users. Propensity score matching (PSM) was used to control for patient age, medical comorbidities, deformity magnitude, and type of surgery performed. Pre- and postoperative patient-reported outcome measures, duration of ICU and hospital stay, perioperative complications, and continued opioid use at one and two years postoperative was evaluated. RESULTS Of 358 eligible patients, 262 were evaluated (mean follow-up=3.5 years). OPIOID (n=98) and NON (n=164) had similar preoperative age, deformity type and magnitude, BMI, smoking history, ASA grade, comorbidity burden, history of smoking and depression, levels fused at surgery, fusion to the pelvis, and 3 column osteotomy (p>0.05). Preoperatively, OPIOID had greater NRS back pain (7.7 vs 6.8) and leg pain (2.5 vs 2.3), worse ODI (50.8 vs 36.9), worse SF-36 PCS (37.3 vs 47.0), and worse SRS-22r self-image (2.0 vs 2.8) than NON, respectively (p 0.05). CONCLUSIONS Propensity score matched analysis of operatively treated ASD patients demonstrated patients using opioids preoperatively have greater baseline and 2-year postoperative disability compared to opioid nonusers, independent of patient demographics, deformity magnitude, and type of surgery performed. Over 50% of preoperative opioid users reported continued postoperative opioid use at one year postoperative, and over 40% had continued use at two years postoperative, compared to 18% and 12% usage at one and two years postoperatively for preoperative nonusers. Attempts should be made to eliminate opioid consumption prior to ASD surgery to improve patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.