When Is Staging the Better Choice?: Identifying Subsets of Adult Spinal Deformity Patient Who Benefit from Staged Surgery

Introduction: There remains a paucity in the literature assessing which patient and surgical variables are predictive of optimal outcome in staged versus same-day procedures, as well as indicators to determine when staging ASD surgery is appropriate.

Methods: ASD patients were stratified based on whether their surgeon chose to perform single-stage or multistage surgery. Means comparison assessed differences between 4 groups: Staged-Optimal/Suboptimal (Staged-O/S) and Same Day-Optimal (SameDay-O/S). Logistic regression and CIT identified thresholds correlating to optimal outcome, defined as >2 of the following: 1) no 90-day reoperation or revision 2) achievement of MCID in ODI 3) no mechanical complication, and 4) no major intraoperative complications.

Results: 902 patients (63.0yrs, 64% F) were isolated. For SameDay-O patients, regression analysis revealed significant factors to be: age < 76.53 years, being classified as Not Frail by mASD-FI, BMI < 30.22 kg/m2, no history of drug/alcohol abuse, no history of renal disease, total levels fused < 9, and no planned VCR or corpectomy (model p < .006). In contrast, for Staged-O patients, significant factors were: age < 83.53 years, being classified as Not Frail or Frail by mASD-FI, BMI < 37.22 kg/m2, history of neurological deficits, history of arthritis, total levels fused < 11, and a UIV below C7 (model p=.002). For SameDay-S patients, factors associated with failure of meeting optimal outcomes were: age > 77.40 years, being classified as Frail or Severely Frail by mASD-FI, and blood loss of > 2010.72 mL. For Staged-S patients, however, only age > 85.60 years and operative time (total) > 540 min was associated with poor outcomes overall (all p < .05).

Conclusion : Though the majority of patients may be equally likely to see optimal results post-operatively regardless of staged/not-staged status, older patients with greater degrees of comorbidities and increased planned surgical invasiveness demonstrate superior outcomes with decreased risk of complications when undergoing staged procedures.