The impact of perioperative complications on clinical outcome in adult deformity surgery

Spine (Phila Pa 1976). 2007 Nov 15;32(24):2764-70. doi: 10.1097/BRS.0b013e31815a7644.


Study design: Retrospective case-control series.

Objective: The purpose of this study is to determine whether perioperative complications alter subsequent clinical outcome measures in adult spinal deformity surgery.

Summary of background data: Increasingly, the benefit of surgical intervention is being evaluated based on patient reported outcomes and standardized health related quality of life (HRQOL) measures. As improvement or deterioration in HRQOL scores becomes a standard for clinical evaluation in adult spinal deformity, the correlation between HRQOL outcome scores and historic benchmarks, such as curve correction, sagittal balance, fusion healing, or the occurrence of a complication, must be clarified.

Methods: This study analyzes a prospective multicenter data base for adult spinal deformity. Patients with major, minor, and no complications were matched using a logistic regression technique producing 46 patients in each group. Standardized outcome measures at baseline and at 1 year postop were compared.

Results: Forty-seven major complications were reported in 46 patients. Sixty-two minor complications were noted in 46 patients. Comparison between the 3 complication groups revealed that 1-year postoperative outcome measures were not statistically different for the Scoliosis Research Society Outcomes Instrument, Medical Outcomes Short Form-36 (SF-12), Oswestry Disability Index, or Numerical Pain Scales. The only significant interaction was in the rate of change from preop to 1-year postop for the SF-12 general health subscale. For the group with major complications, SF-12 general health deteriorated by 2.1 points from preop to 1-year postop. During the same period, the group with minor complications experienced an improvement of 4.2 points and the group with no complications experienced an improvement of 1.5 points.

Conclusion: This study suggests that risk for minor complications may be a less substantial obstacle than previously assumed for surgical treatment in adult spinal deformity. In contrast, major complications were reported in approximately 10% of cases and adversely affected outcome as evidenced by the deterioration in SF-12 general health scores at 1 year after surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Intraoperative Complications / epidemiology*
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Quality of Life
  • Retrospective Studies
  • Risk Factors
  • Spinal Diseases / epidemiology*
  • Spinal Diseases / surgery*
  • Spinal Fusion / statistics & numerical data*
  • Treatment Outcome