• Peter G Passias, Eric O Klineberg, Cyrus M Jalai, Nancy Worley, Gregory W Poorman, Breton Line, Cheongeun Oh, Douglas C Burton, Han Jo Kim, Daniel M Sciubba, D Kojo Hamilton, Christopher P Ames, Justin S Smith, Christopher I Shaffrey, Virginie Lafage, and Shay Bess.
• *Department of Orthopaedic Surgery NYU Medical Center Hospital for Joint Diseases †Department of Orthopaedic Surgery, University of California Davis, Sacramento ‡Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado §Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City ¶Department of Orthopaedics, Hospital for Special Surgery, New York, New York ||Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland **Department of Neurological Surgery, University of Pittsburgh School of Medicine ††Neurosurgery, University of California San Francisco, California ‡‡Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
• Spine. 2016 Mar 8.

Study DesignRetrospective review of prospective multicenter database.ObjectiveIdentify factors influencing readmission, reoperation, and the impact on health related quality of life outcomes (HRQoL's) in adult spinal deformity (ASD) surgery.Summary Of Background DataMany ASD patients experience complications requiring readmission. It is important to identify baseline/operative factors leading to rehospitalizations and reoperation, which may impact outcomes.MethodsInclusion criteria: ASD surgical patients (age > 18years, major coronal Cobb≥20°, SVA≥5 cm, PT≥25° and/or TK > 60°) with complete baseline, 1-, and 2-year follow-up. Patients were grouped on the basis of readmission occurrence (yes/no) and type (medical [no reoperation] vs. surgical [revision surgery]). Readmissions caused by infections requiring surgical treatment (e.g. deep infections) were considered reoperations. Univariate and multivariate analyses determined readmission and reoperation predictors. Repeated measures mixed models evaluated readmission impact on HRQoL's at 1- and 2-years.Results334 patients were included: 76 (22.8%) readmissions, involving 65 (85.5% of 76) reoperations (surgical readmission) and 11 (14.5% of 76) medical readmissions. The most common surgical readmission indication (n = 65) was implant complications (36.9%; rod breakage n = 13); the most common medical readmission indication was infection (36.4%, n = 4), treated with antibiotics. Non-infectious medical readmission (n = 7) included: pleural effusion, DTV, intra-operative blood loss, neurologic, and unspecified. Readmission predictors: increased number of major peri-operative complications (OR 5.13, p = 0.014), infection presence (OR 25.02, p = 0.001), implant complications (OR 6.12, p < 0.001), and radiographic complications (DJK, PJK, pseudoarthrosis, sagittal/coronal imbalance) (OR 16.94, p < 0.001). HRQoL analysis revealed overall improvement of the full cohort (p < 0.01), though the 76 readmitted improved less overall and at each time point p < 0.001) except in 6-week MCS (p = 0.14).ConclusionsMajor peri-operative, implant, radiographic, and infection complications during index were associated with increased readmission odds. Implant complications most frequently caused surgical readmissions. Readmitted patients improved in outcome scores, although less compared to the non-readmitted cohort, yet displayed reduced 6-week SF-36 MCS.Level Of Evidence3.

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