Resident Physician University of Pennsylvania Rochester, New York, United States
Introduction: Patients often undergo circumferential (anterior and posterior) spinal fusions to maximize adult spinal deformity (ASD) correction and achieve adequate fusion. Currently, such procedures are performed in staged or same-day procedures with limited evidence to support either strategy. This study aims to compare perioperative outcomes and costs of staged (ST) vs. same-day (SD) circumferential ASD corrective surgeries.
Methods: This is a retrospective review of patients undergoing circumferential ASD surgeries between 2013 – 2018 in a single institution. Patient characteristics, preoperative comorbidities, surgical details, perioperative complications, readmissions, total hospital admission costs, and 90-day postoperative care costs were identified. All variables were tested for differences between ST and SD groups unadjusted and after applying inverse probability weighting (IPW) to control for the number of levels fused, and the results before and after IPW were compared.
Results: The entire cohort included a total of 211 (ST= 50, SD=161) patients, 100 of which (ST=44, SD=56) underwent over four levels fused posteriorly. There was no difference in patient characteristics including age, sex, BMI, smoking status and race between ST or SD groups after IPW. In the whole cohort, the ST group had a higher rate of postoperative complications (OR 2.97, p=0.001) and on IPW, pulmonary embolism was significantly higher in ST versus SD (12% versus 1.2%, p=0.0451). In the long segment (LS) group, post-operative pulmonary embolism was more common in staged procedures than same-day on univariate and IPW analyses (OR=13.0, p=0.24). After IPW, both groups were not significantly different in disposition, 30-day readmissions, or reoperations. Within the LS cohort, the ST group showed significantly longer LOS (10.5 days versus 6.2 days); the ST group was expected to have length of stay 1.7 times longer than the SD group (p-value < 0.0001). Admissions costs on IPW in the LS cohort were 1.5 times greater in the ST group (95% CI 1.1730, 1.8728, p=0.0013).
Conclusion : Adjusted comparisons between ST and SD groups showed staging to be associated with significantly greater LOS, pulmonary embolism and admission costs.
