• Robert Daniel Bass, Renaud Lafage, Justin S Smith, Christopher Ames, Shay Bess, Robert Eastlack, Munish Gupta, Richard Hostin, Khaled Kebaish, Han Jo Kim, Eric Klineberg, Gregory Mundis, David Okonkwo, Christopher Shaffrey, Frank Schwab, Virginie Lafage, Douglas Burton, and International Spine Study Group.
• Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY.
• Spine. 2024 Sep 15; 49 (18): 125912681259-1268.

ObjectiveThe aim of this study was to provide benchmarks for the rates of complications by type of surgery performed.Study DesignProspective multicenter database.BackgroundWe have previously examined overall construct survival and complication rates for ASD surgery. However, the relationship between type of surgery and construct survival warrants more detailed assessment.Materials And MethodsEight surgical scenarios were defined based on the levels treated, previous fusion status [primary (P) vs. revision (R)], and three-column osteotomy use (3CO): short lumbar fusion, LT-pelvis with 5 to 12 levels treated (P, R, or 3CO), UT-pelvis with 13 levels treated (P, R, or 3CO), and thoracic to lumbar fusion without pelvic fixation, representing 92.4% of the case in the cohort. Complication rates for each type were calculated and Kaplan-Meier curves with multivariate Cox regression analysis was used to evaluate the effect of the case characteristics on construct survival rate, while controlling for patient profile.ResultsA total of 1073 of 1494 patients eligible for 2-year follow-up (71.8%) were captured. Survival curves for major complications (with or without reoperation), while controlling for demographics differed significantly among surgical types ( P <0.001). Fusion procedures short of the pelvis had the best survival rate, while UT-pelvis with 3CO had the worst survival rate. Longer fusions and more invasive operations were associated with lower 2-year complication-free survival, however, there were no significant associations between type of surgery and renal, cardiac, infection, wound, gastrointestinal, pulmonary, implant malposition, or neurological complications (all P >0.5).ConclusionsThis study suggests that there is an inherent increased risk of complication for some types of ASD surgery independent of patient profile. The results of this paper can be used to produce a surgery-adjusted benchmark for ASD surgery with regard to complications and survival. Such a tool can have very impactful applications for surgical decision-making and more informed patient counseling.Level Of EvidenceLevel III.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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