Critical Analysis of Radiographic and Patient-Reported Outcomes Following Anterior/Posterior Staged Versus Same-Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity
Authors: Passias Peter G. , Ahmad Waleed , Tretiakov Peter S. , Lafage Renaud , Lafage Virginie , Schoenfeld Andrew J. , Line Breton , Daniels Alan , Mir Jamshaid M. , Gupta Munish , Mundis Gregory , Eastlack Robert , Nunley Pierce , Hamilton D. Kojo , Hostin Richard , Hart Robert , Burton Douglas C. , Shaffrey Christopher , Schwab Frank , Ames Christopher , Smith Justin S. , Bess Shay , Klineberg Eric O. ,   on behalf of the International Spine Study Group
Published: July 2023

Study Design.
A retrospective cohort study of a prospectively collected multicenter adult spinal deformity (ASD) database.

Objective.
The aim of this study was to compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for the treatment of ASD.

Background.
Surgical intervention for ASD is an invasive and complex procedure that surgeons often elect to perform on different days (staging). Yet, there remains a paucity of literature on the timing and effects of the interval between stages.

Materials and Methods.
ASD patients with 2-year data undergoing an anterior/posterior (A/P) fusion to the ilium were included. Propensity score matching was performed for the number of levels fused, number of interbody devices, surgical approaches, number of osteotomies/three-column osteotomy, frailty, Oswestry Disability Index, Charlson Comorbidity Index, revisions, sagittal vertical axis, pelvic incidence−lumbar lordosis, and upper instrumented vertebrae to create balanced cohorts of same-day and staged surgical patients. Staged patients were stratified by intervening time-period between surgeries, using quartiles.

Results.
A total of 176 propensity score–matched patients were included. The median interval between A/P staged procedures was 3 days. Staged patients had greater operative time and lower intensive care unit stays postoperatively (P<0.05). At 2 years, staged compared with same-day showed a greater improvement in T1 slope−cervical lordosis, C2 sacral slope, and SRS-Schwab sagittal vertical axis (P<0.05). Staged patients had higher rates of minimal clinically important difference for 1-year SRS-Appearance and 2-year Physical Component Summary scores. Assessing different intervals of staging, patients at the 75th percentile interval showed greater improvement in 1-year SRS-Pain and SRS-Total postoperative as well as SRS-Activity, Pain, Satisfaction, and Total scores (P<0.05) compared with patients in lower quartiles. Compared with the 25th percentile, patients reaching the 50th percentile interval were associated with increased odds of improvement in Global Alignment and Proportion score proportionality [9.3 (1.6–53.2), P=0.01].

Conclusions.
This investigation is among the first to compare multicenter staged and same-day surgery A/P ASD patients fused to ilium using propensity matching. Staged procedures resulted in significant improvement radiographically, reduced intensive care unit admissions, and superior patient-reported outcomes compared with same-day procedures. An interval of at least 3 days between staged procedures is associated with superior outcomes in terms of Global Alignment and Proportion score proportionality.