• Eric O Klineberg, Peter G Passias, Cyrus M Jalai, Nancy Worley, Daniel M Sciubba, Douglas C Burton, Munish C Gupta, Alex Soroceanu, Luke P Zebala, Gregory M Mundis, Han Jo Kim, D Kojo Hamilton, Robert A Hart, Christopher P Ames, Virginie Lafage, and International Spine Study Group.
• Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California.
• Spine. 2016 Jul 1; 41 (13): E798-E805.

Study DesignA retrospective review of a prospective multicenter database.ObjectiveThe aim of this study was to identify variables associated with extended length of stay (ExtLOS) and this impact on health-related quality of life (HRQoL) scores in adult spinal deformity (ASD) patients.Summary Of Background DataASD surgery is complex and associated with complications including extLOS. Although variables contributing to extLOS have been considered, specific complications and pre-disposing factors among ASD surgical patients remain to be investigated.MethodsInclusion CriteriaASD surgical patients (age >18 years, scoliosis ≥20°, sagittal vertical axis ≥5 cm, pelvic tilt ≥25°, and/or thoracic kyphosis >60°) with complete demographic, radiographic, and HRQoL data at baseline, 6 weeks, and 2 years postoperative. ExtLOS was based on 75th percentile (≥9 days). Univariate and multivariate analyses identified predictors and evaluated effects on outcomes. Repeated-measures mixed models analyzed impact of ExtLOS on HRQoL [Oswestry Disability Index; Short Form-36 physical component summary/mental component summary; SRS22r Activity (AC), Pain (P), Appearance (AP), Satisfaction (S), Mental (M) and Total (T)].ResultsThree hundred eighty patients met inclusion criteria: 105 (27.6%) had extLOS (≥9 days) and 275 (72.4%) did not. Average LOS was 8 days (range: 1-30 days). Age [odds ratio (OR) 1.04], no. of levels fused (OR 1.12), no. of infections (OR 2.29), no. of neurologic complications (OR 2.51), Charlson Comorbidity Index Score (CCI) predicted ExtLOS (OR 3.92), and no. of intraop complications predicted ExtLOS (OR 3.56). ExtLOS patients had more intracardiopulmonary (pleural effusion: 1.9% vs. 0%) and operative complications (dural tear: 13.3% vs. 5.1%; excessive blood loss: 18% vs. 5.8%) (P < 0.022). At 2 years, both groups of patients experienced an overall improvement in all HRQoL scores (P < 0.001). ExtLOS patients had significantly less overall improvement in all HRQoLs (P < 0.01) except for MCS (P = 0.17) and SRS M (P = 0.08).ConclusionExtended LOS of ASD patients is affected by comorbidities (higher CCI) and number of intraoperative, but not peri-operative, complications. All patients improved overall in HRQoL scores, but extended LOS patients improved less overall at 2 years in comparison.Level Of Evidence3.

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