P.090 The predictors of patient morbidity after adult spinal deformity correction: bone mineral density and the extent of deformity correction

Abstract

Suppl. 2 -S36in application, and temporal trends of usage. Methods: A prospectively-collected database of provincial insurance billables and diagnostic codes was reviewed retrospectively, from [2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014]. Patients undergoing instrumented spinal fusions or percutaneous vertebroplasty/kyphoplasty were identified. Fee and diagnostic codes were applied to distinguish surgical indication and approach. The use of intra-operative navigation was determined for each case. Results: We identified 4607 instrumented spinal fusions in our cohort. Most cases were performed by orthopedic surgeons (63.2%) and the remainder by neurosurgeons. Of 2239 cases with identifiable etiology, CAN was utilized in 8.8%, predominantly for trauma and degenerative pathologies rather than deformity. In univariate analyses, CAN was used more often by neurosurgeons (21.0% vs. 12.4%, p<0.001), in academic institutions (15.9% vs. 12.3%, p<0.001), and when performed in/after 2010 (18.9% vs. 8.9%, p<0.001). Differences by specialty and year remained significant in multiple logistic regression. Conclusions: Spinal CAN has proven benefit for instrumentation accuracy, but is used preferentially by academic neurosurgeons. Significant gains must be made in cost and usability to improve access across disciplines and institutions. Background: Morbidity can be high in the management of adult spinal deformity patients. Complications include blood loss (EBL), durotomy, radicular pain, and postoperative hardware failure. Utilization of one versus two spinal surgeons in spinal deformity correction reduces overall perioperative morbidity is unclear. Methods: All procedures were performed by surgeons at a single institution between January 2012-2015. Patients were followed for a minimum of one year and maximum of four years. We retrospectively reviewed 60 cases of adult spinal deformity. Our cohort was divided into 1 versus 2 surgeons (12 vs 48 cases). We analyzed these cases for estimated blood loss and peri-operative complications. Results: Cases involving long thoracic to pelvis correction (T3-T6) was 20.8% in the 2 surgeons group and 8.3% in the 1 surgeon group. The EBL >3.0 L for 1 versus 2 surgeon groups were 25% and 41.6% respectively. Major complications in the 1 versus 2 surgeon group were 25% and 47.9% and the revision rates were 25% versus 37.5%. The percentage of minor complications in the 1 versus 2 surgeon group was 33.3% versus 14.6%. Conclusions: Utilizing two surgeons did not reduce complication rates. Procedures performed by two surgeons were more extensive deformity corrections. The extent of correction is the likely explanation for differing complication rates.