• Wesley M Durand, Jacob M Babu, David K Hamilton, Peter G Passias, Han Jo Kim, Themistocles Protopsaltis, Virginie Lafage, Renaud Lafage, Justin S Smith, Christopher Shaffrey, Munish Gupta, Michael P Kelly, Eric O Klineberg, Frank Schwab, Jeffrey L Gum, Gregory Mundis, Robert Eastlack, Khaled Kebaish, Alex Soroceanu, Richard A Hostin, Doug Burton, Shay Bess, Christopher Ames, Robert A Hart, Alan H Daniels, and International Spine Study Group (ISSG).
• Johns Hopkins University School of Medicine, Baltimore, MD.
• Spine. 2022 Feb 15; 47 (4): 287294287-294.

Study DesignRetrospective cohort study.ObjectiveWe hypothesized that adult spinal deformity (ASD) surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism.Summary Of Background DataASD patients experience markedly decreased health-related quality of life along many dimensions.MethodsOnly patients eligible for 2-year follow-up were included, and those with a history of previous spinal fusion were excluded. The primary outcome measures in this study were Scoliosis Research Society-22r score (SRS-22r) questions 9 and 17. A repeated measures mixed linear regression was used to analyze responses over time among patients managed operatively (OP) versus nonoperatively (NON-OP).ResultsIn total, 1188 patients were analyzed. 66.6% were managed operatively. At baseline, the mean percentage of activity at work/school was 56.4% (standard deviation [SD] 35.4%), and the mean days off from work/school over the past 90 days was 1.6 (SD 1.8). Patients undergoing ASD surgery exhibited an 18.1% absolute increase in work/school productivity at 2-year follow-up versus baseline (P < 0.0001), while no significant change was observed for the nonoperative cohort (P > 0.5). Similarly, the OP cohort experienced 1.1 fewer absent days over the past 90 days at 2 years versus baseline (P < 0.0001), while the NON-OP cohort showed no such difference (P > 0.3). These differences were largely preserved after stratifying by baseline employment status, age group, sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), and deformity curve type.ConclusionASD patients managed operatively exhibited an average increase in work/school productivity of 18.1% and decreased absenteeism of 1.1 per 90 days at 2-year follow-up, while patients managed nonoperatively did not exhibit change from baseline. Given the age distribution of patients in this study, these findings should be interpreted as pertaining primarily to obligations at work or within the home. Further study of the direct and indirect economic benefits of ASD surgery to patients is warranted.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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