Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: A retrospective review of 423 patients

Kristina Bianco, Robert Norton, Frank Schwab, Justin S. Smith, Eric Otto Klineberg, Ibrahim Obeid, Gregory MundisJr, Christopher I. Shaffrey, Khaled Kebaish, Richard Hostin, Robert Hart, Munish C. Gupta, Douglas Burton, Christopher Ames, Oheneba Boachie-Adjei, Themistocles S. Protopsaltis, Virginie Lafage

Research output: Contribution to journalArticle

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Abstract

Object: Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods: The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results: Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions: Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL

Original languageEnglish (US)
Article numberE18
JournalNeurosurgical Focus
Volume36
Issue number5
DOIs
StatePublished - 2014

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Osteotomy
Spine
Intraoperative Complications
Incidence
Thorax
Population
Operating Rooms
Blood Volume
Spinal Cord

Keywords

  • Intercenter variability
  • Major complication
  • Pedicle subtraction osteotomy
  • Spinal deformity
  • Three-column osteotomy
  • Vertebral column resection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Medicine(all)

Cite this

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery : A retrospective review of 423 patients. / Bianco, Kristina; Norton, Robert; Schwab, Frank; Smith, Justin S.; Klineberg, Eric Otto; Obeid, Ibrahim; MundisJr, Gregory; Shaffrey, Christopher I.; Kebaish, Khaled; Hostin, Richard; Hart, Robert; Gupta, Munish C.; Burton, Douglas; Ames, Christopher; Boachie-Adjei, Oheneba; Protopsaltis, Themistocles S.; Lafage, Virginie.

In: Neurosurgical Focus, Vol. 36, No. 5, E18, 2014.

Research output: Contribution to journalArticle

Bianco, K, Norton, R, Schwab, F, Smith, JS, Klineberg, EO, Obeid, I, MundisJr, G, Shaffrey, CI, Kebaish, K, Hostin, R, Hart, R, Gupta, MC, Burton, D, Ames, C, Boachie-Adjei, O, Protopsaltis, TS & Lafage, V 2014, 'Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: A retrospective review of 423 patients', Neurosurgical Focus, vol. 36, no. 5, E18. https://doi.org/10.3171/2014.2.FOCUS1422
Bianco, Kristina ; Norton, Robert ; Schwab, Frank ; Smith, Justin S. ; Klineberg, Eric Otto ; Obeid, Ibrahim ; MundisJr, Gregory ; Shaffrey, Christopher I. ; Kebaish, Khaled ; Hostin, Richard ; Hart, Robert ; Gupta, Munish C. ; Burton, Douglas ; Ames, Christopher ; Boachie-Adjei, Oheneba ; Protopsaltis, Themistocles S. ; Lafage, Virginie. / Complications and intercenter variability of three-column osteotomies for spinal deformity surgery : A retrospective review of 423 patients. In: Neurosurgical Focus. 2014 ; Vol. 36, No. 5.
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title = "Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: A retrospective review of 423 patients",
abstract = "Object: Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods: The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results: Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7{\%}, 39{\%}, and 42{\%}, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6{\%}) and the most common POC was unplanned return to the operating room (19.4{\%}). Patients with two osteotomies had more POCs (56{\%} vs 38{\%}, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16{\%} vs 6{\%}, p = 0.03), POCs (58{\%} vs 34{\%}, p < 0.01), and overall complications (67{\%} vs 37{\%}, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24{\%} for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55{\%} for the study population, which also varied among sites (p < 0.01). Conclusions: Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42{\%}. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL",
keywords = "Intercenter variability, Major complication, Pedicle subtraction osteotomy, Spinal deformity, Three-column osteotomy, Vertebral column resection",
author = "Kristina Bianco and Robert Norton and Frank Schwab and Smith, {Justin S.} and Klineberg, {Eric Otto} and Ibrahim Obeid and Gregory MundisJr and Shaffrey, {Christopher I.} and Khaled Kebaish and Richard Hostin and Robert Hart and Gupta, {Munish C.} and Douglas Burton and Christopher Ames and Oheneba Boachie-Adjei and Protopsaltis, {Themistocles S.} and Virginie Lafage",
year = "2014",
doi = "10.3171/2014.2.FOCUS1422",
language = "English (US)",
volume = "36",
journal = "Neurosurgical Focus",
issn = "1092-0684",
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TY - JOUR

T1 - Complications and intercenter variability of three-column osteotomies for spinal deformity surgery

T2 - A retrospective review of 423 patients

AU - Bianco, Kristina

AU - Norton, Robert

AU - Schwab, Frank

AU - Smith, Justin S.

AU - Klineberg, Eric Otto

AU - Obeid, Ibrahim

AU - MundisJr, Gregory

AU - Shaffrey, Christopher I.

AU - Kebaish, Khaled

AU - Hostin, Richard

AU - Hart, Robert

AU - Gupta, Munish C.

AU - Burton, Douglas

AU - Ames, Christopher

AU - Boachie-Adjei, Oheneba

AU - Protopsaltis, Themistocles S.

AU - Lafage, Virginie

PY - 2014

Y1 - 2014

N2 - Object: Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods: The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results: Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions: Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL

AB - Object: Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods: The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results: Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions: Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL

KW - Intercenter variability

KW - Major complication

KW - Pedicle subtraction osteotomy

KW - Spinal deformity

KW - Three-column osteotomy

KW - Vertebral column resection

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