Revision Risk After Primary Adult Spinal Deformity Surgery: A Nationwide Study With Two-Year Follow-up

Frederik T. Pitter; Martin Lindberg-Larsen; Alma B. Pedersen; Benny Dahl; Martin Gehrchen

doi:10.1016/j.jspd.2018.10.006

Revision Risk After Primary Adult Spinal Deformity Surgery: A Nationwide Study With Two-Year Follow-up

Frederik T. Pitter^*, Martin Lindberg-Larsen, Alma B. Pedersen, Benny Dahl, Martin Gehrchen

^*Corresponding author for this work

Department of Clinical Medicine

5 Citations (Scopus)

Abstract

Study Design: Cohort study. Objectives: To report the two-year revision risk following primary adult spinal deformity (ASD) surgery, describe reasons for revisions, and assess risk factors for revision surgery. Summary of Background Data: Revision risk following primary ASD surgery has been reported to vary between 7% and 26%, but with loss to follow-up as a considerable challenge. Methods: Patients ≥18 years of age undergoing primary instrumented surgery for ASD in Denmark during 2006–2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Complete two-year follow-up on revision surgery for each patient was achieved. Medical records were reviewed to determine reasons for revisions. Overall comorbidity was summarized using the Charlson Comorbidity Index (CCI) based on DNPR data; low comorbidity (CCI 0); medium comorbidity (CCI 1–2); and high comorbidity (CCI ≥3). Risk factors for revision were assessed in a Cox regression model. Results: A total of 553 patients were identified. Of these, 19.9% were revised within the two-year follow-up and 7.2% of patients were revised more than once. Median time to revision was 308 days (interquartile range 105–508). The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio [HR] = 1.13, 95% confidence interval [CI] 1.01–1.26, per 10 years increment) and high comorbidity burden (HR = 2.10, 95% CI 1.16–3.79) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; hence, year of primary surgery (with 2006 as reference) was associated with increased revision risk (HR = 1.09, 95% CI 1.01–1.18). Conclusions: The revision risk within 2 years after primary ASD surgery was 19.9% nationwide in Denmark, and implant failure was the most common reason for revision. Increased comorbidity and age were separately associated with increased risk of revision. Level of Evidence: Level II.

Original language	English
Journal	Spine Deformity
ISSN	2212-134X
DOIs	https://doi.org/10.1016/j.jspd.2018.10.006
Publication status	Published - Jul 2019

Keywords

Adult spinal deformity
Charlson Comorbidity Index
Nationwide follow-up
Primary surgery
Revision risk

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10.1016/j.jspd.2018.10.006

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@article{fed8dace2388432a811604422074e656,

title = "Revision Risk After Primary Adult Spinal Deformity Surgery: A Nationwide Study With Two-Year Follow-up",

abstract = "Study Design: Cohort study. Objectives: To report the two-year revision risk following primary adult spinal deformity (ASD) surgery, describe reasons for revisions, and assess risk factors for revision surgery. Summary of Background Data: Revision risk following primary ASD surgery has been reported to vary between 7% and 26%, but with loss to follow-up as a considerable challenge. Methods: Patients ≥18 years of age undergoing primary instrumented surgery for ASD in Denmark during 2006–2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Complete two-year follow-up on revision surgery for each patient was achieved. Medical records were reviewed to determine reasons for revisions. Overall comorbidity was summarized using the Charlson Comorbidity Index (CCI) based on DNPR data; low comorbidity (CCI 0); medium comorbidity (CCI 1–2); and high comorbidity (CCI ≥3). Risk factors for revision were assessed in a Cox regression model. Results: A total of 553 patients were identified. Of these, 19.9% were revised within the two-year follow-up and 7.2% of patients were revised more than once. Median time to revision was 308 days (interquartile range 105–508). The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio [HR] = 1.13, 95% confidence interval [CI] 1.01–1.26, per 10 years increment) and high comorbidity burden (HR = 2.10, 95% CI 1.16–3.79) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; hence, year of primary surgery (with 2006 as reference) was associated with increased revision risk (HR = 1.09, 95% CI 1.01–1.18). Conclusions: The revision risk within 2 years after primary ASD surgery was 19.9% nationwide in Denmark, and implant failure was the most common reason for revision. Increased comorbidity and age were separately associated with increased risk of revision. Level of Evidence: Level II.",

keywords = "Adult spinal deformity, Charlson Comorbidity Index, Nationwide follow-up, Primary surgery, Revision risk",

author = "Pitter, {Frederik T.} and Martin Lindberg-Larsen and Pedersen, {Alma B.} and Benny Dahl and Martin Gehrchen",

year = "2019",

month = jul,

doi = "10.1016/j.jspd.2018.10.006",

language = "English",

journal = "Spine Deformity",

issn = "2212-134X",

publisher = "Elsevier",

}

TY - JOUR

T1 - Revision Risk After Primary Adult Spinal Deformity Surgery

T2 - A Nationwide Study With Two-Year Follow-up

AU - Pitter, Frederik T.

AU - Lindberg-Larsen, Martin

AU - Pedersen, Alma B.

AU - Dahl, Benny

AU - Gehrchen, Martin

PY - 2019/7

Y1 - 2019/7

N2 - Study Design: Cohort study. Objectives: To report the two-year revision risk following primary adult spinal deformity (ASD) surgery, describe reasons for revisions, and assess risk factors for revision surgery. Summary of Background Data: Revision risk following primary ASD surgery has been reported to vary between 7% and 26%, but with loss to follow-up as a considerable challenge. Methods: Patients ≥18 years of age undergoing primary instrumented surgery for ASD in Denmark during 2006–2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Complete two-year follow-up on revision surgery for each patient was achieved. Medical records were reviewed to determine reasons for revisions. Overall comorbidity was summarized using the Charlson Comorbidity Index (CCI) based on DNPR data; low comorbidity (CCI 0); medium comorbidity (CCI 1–2); and high comorbidity (CCI ≥3). Risk factors for revision were assessed in a Cox regression model. Results: A total of 553 patients were identified. Of these, 19.9% were revised within the two-year follow-up and 7.2% of patients were revised more than once. Median time to revision was 308 days (interquartile range 105–508). The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio [HR] = 1.13, 95% confidence interval [CI] 1.01–1.26, per 10 years increment) and high comorbidity burden (HR = 2.10, 95% CI 1.16–3.79) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; hence, year of primary surgery (with 2006 as reference) was associated with increased revision risk (HR = 1.09, 95% CI 1.01–1.18). Conclusions: The revision risk within 2 years after primary ASD surgery was 19.9% nationwide in Denmark, and implant failure was the most common reason for revision. Increased comorbidity and age were separately associated with increased risk of revision. Level of Evidence: Level II.

AB - Study Design: Cohort study. Objectives: To report the two-year revision risk following primary adult spinal deformity (ASD) surgery, describe reasons for revisions, and assess risk factors for revision surgery. Summary of Background Data: Revision risk following primary ASD surgery has been reported to vary between 7% and 26%, but with loss to follow-up as a considerable challenge. Methods: Patients ≥18 years of age undergoing primary instrumented surgery for ASD in Denmark during 2006–2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Complete two-year follow-up on revision surgery for each patient was achieved. Medical records were reviewed to determine reasons for revisions. Overall comorbidity was summarized using the Charlson Comorbidity Index (CCI) based on DNPR data; low comorbidity (CCI 0); medium comorbidity (CCI 1–2); and high comorbidity (CCI ≥3). Risk factors for revision were assessed in a Cox regression model. Results: A total of 553 patients were identified. Of these, 19.9% were revised within the two-year follow-up and 7.2% of patients were revised more than once. Median time to revision was 308 days (interquartile range 105–508). The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio [HR] = 1.13, 95% confidence interval [CI] 1.01–1.26, per 10 years increment) and high comorbidity burden (HR = 2.10, 95% CI 1.16–3.79) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; hence, year of primary surgery (with 2006 as reference) was associated with increased revision risk (HR = 1.09, 95% CI 1.01–1.18). Conclusions: The revision risk within 2 years after primary ASD surgery was 19.9% nationwide in Denmark, and implant failure was the most common reason for revision. Increased comorbidity and age were separately associated with increased risk of revision. Level of Evidence: Level II.

KW - Adult spinal deformity

KW - Charlson Comorbidity Index

KW - Nationwide follow-up

KW - Primary surgery

KW - Revision risk

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U2 - 10.1016/j.jspd.2018.10.006

DO - 10.1016/j.jspd.2018.10.006

M3 - Journal article

C2 - 31202380

AN - SCOPUS:85058969582

SN - 2212-134X

JO - Spine Deformity

JF - Spine Deformity

ER -

Revision Risk After Primary Adult Spinal Deformity Surgery: A Nationwide Study With Two-Year Follow-up

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Keywords

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