Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult...

Area of Science:

• Spine surgery outcomes
• Adult spinal deformity (ASD)
• High-risk surgical patients

Background:

• Adult spinal deformity (ASD) surgery patient baseline risk (age, frailty, deformity severity) is highly variable.
• Past decade improvements in ASD surgery are noted, but their impact on high-risk patients remains unclear.

Purpose of the Study:

• To determine temporal differences in 2-year outcomes for ASD surgery patients stratified by baseline risk.
• To assess if recent advancements in ASD surgery benefit high-risk patient populations.

Main Methods:

• Patients (≥18 years) with pre- and 2-year postoperative data (2009-2018) were categorized into early (2009-2013) and late (2014-2018) surgical groups.
• High-risk (HR) patients met ≥2 criteria: severe deformity, age ≥70, severe frailty, high comorbidity index, 3-column osteotomy, or extensive fusion (>12 levels / >7 for elderly).
• Demographics, clinical outcomes, radiographic alignment, and complication rates were compared between early and late HR patient groups.

Main Results:

• No significant differences in achieving radiographic alignment goals were observed between early and late groups.
• Late/HR patients showed significantly better clinical outcomes (SRS, Oswestry Disability Index) compared to early/HR patients.
• Late/HR patients experienced fewer overall complications (63% vs. 74%), reoperations (17% vs. 30%), surgical infections (0.9% vs. 4.3%), and proximal junctional issues (PJK/PJF).

Conclusions:

• Despite an increase in high-risk patients undergoing surgery in the later period (2014-2018), outcomes improved.
• Surgeons successfully reduced complication, mechanical failure, and reoperation rates in high-risk patients.
• Health-related quality of life was simultaneously enhanced for high-risk patients in the later surgical period.