The Differences Between Same-Day and Staged (Circumferential) Fusion Surgery in Adult Spinal Deformity: Protocol for a Systematic Review
Authors: Dagli Mert Marcel , Narang Shivek , Malhotra Kashish , Santangelo Gabrielle , Wathen Connor , Ghenbot Yohannes , Macaluso Dominick , Albayar Ahmed , Ozturk Ali Kemal , Welch William C 
Published: November 2022

Background
Adult spinal deformity (ASD) is a deformity in the curvature of the adult spine. ASD includes a range of pathology that leads to decreased quality of life for patients as well as debilitating morbidities. Treatment can range from nonoperative management to long-segment surgical corrections and depends greatly on the deformity and patient profiles. If surgical treatment is indicated, circumferential (a combined anterior and posterior approach) fusion is one of the tools in the spine surgeon’s armamentarium. Depending on the complexity, the procedure is either completed on the same day or staged. Determining whether to perform a circumferential surgery in a staged fashion is based largely on the surgeon’s preference and perception of the individual case complexity; at present, there is no high-quality evidence that can be used to support that decision.

Objective
This paper presents the protocol for a systematic review that aims to investigate the differences between same-day versus staged circumferential fusion surgery in ASD both in patient selection and in outcomes.

Methods
Searches will be performed on MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. Gray literature and the reference lists of articles included in the full-text screening will also be screened for inclusion. Results will be exported to Covidence. Data will be collected on demographics, type of procedures performed, surgery levels, blood loss, total operation time, length of stay, disposition, readmissions (30 days and 90 days), and perioperative complications. Patient-reported outcomes will also be assessed. Data quality assessment of randomized controlled trials will be performed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials, and nonrandomized studies will be assessed with the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool. All screening, quality assessment, and data extraction will be done by 2 independent reviewers. A descriptive synthesis will be performed, and data will be evaluated for further analysis.

Results
This study is currently in the screening phase. There are no results yet. The search strategy has been developed and documented. Information has been exported to Covidence. Upon conclusion of the critical appraisal stage, screening and extraction, as well as a synthesis of the results, will be performed.

Conclusions
The intended review will summarize the differences in perioperative outcomes and complications between same-day and staged (circumferential) fusion surgery in adult spinal deformity. It will also describe the patients selected for such procedures based on their demographics and pathology. Identified gaps in knowledge will provide insight into current limitations and guide further studies on this topic.

Trial Registration
PROSPERO CRD42022339764; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339764

International Registered Report Identifier (IRRID)
PRR1-10.2196/42331