Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis.

Abstract

STUDY DESIGN:

Longitudinal cohort.

OBJECTIVES:

To identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity.

SUMMARY OF BACKGROUND DATA:

Increasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient's health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity.

METHODS:

The data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events.

RESULTS:

Of 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071).

CONCLUSIONS:

Factors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient's quality of life.

LEVEL OF EVIDENCE:

Level II. Prospective cohort.

• Authors: Leah Y Carreon, Steven D Glassman, Christopher I Shaffrey, Michael G Fehlings, Benny Dahl, Christopher P Ames, Yukihiro Matsuyama, Yong Qiu, Hossein Mehdian, Kenneth M C Cheung, Frank J Schwab, Ferran Pellisé, Khaled M Kebaish, Lawrence G Lenke
• Journal: Spine deformity (Spine Deform) Vol. 5 Issue 2 Pg. 139-144 (03 2017) ISSN: 2212-1358 [Electronic] England
• PMID: 28259266 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Female
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Osteotomy (adverse effects, methods, psychology)
• Postoperative Complications (etiology, psychology)
• Postoperative Period
• Prospective Studies
• Quality of Life
• Regression Analysis
• Risk Assessment
• Risk Factors
• Scoliosis (psychology, surgery)
• Severity of Illness Index
• Treatment Outcome
• Young Adult