Impact of Patient Comorbidities on Functional and Patient-Reported Outcomes Following Correction Surgery for Adult Spinal Deformity

Introduction: Adult spinal deformity (ASD) affects a significant portion of the elderly population secondary to spinal degeneration. Management of patient comorbid conditions is crucial in achieving positive outcomes following deformity correction surgery in this population. Here we assess the impact of preexisting patient comorbidities on several reported outcome measures in patients undergoing deformity correction thoracolumbar surgery for ASD.

Methods: We performed a retrospective review of 235 patients who underwent thoracolumbar adult spinal deformity (ASD) correction surgery (≥4 levels). Primary patient deformities were degenerative scoliosis and failed back syndrome. Outcome measurements, including complications, revision surgeries, ICU and total hospital length of stay, readmissions, Oswestry Disability Index (ODI) scores, PROMIS-29 scores, and Visual Analog Scale (VAS) pain scores, were assessed in relation to multiple demographics and patient comorbidities (smoking status, hypertension, diabetes mellitus, psychiatric disorders, heart conditions, etc.).

Results: Following analysis, patients who were current or former smokers had a significantly higher risk of complications (OR = 2.08, 95%CI = 1.14-3.85, p < 0.05) and thus higher average number of revision surgeries (0.585 vs. 0.430, p< 0.05). Patients with comorbid CKD had increased total number of levels fused (10.35 vs. 9.18, p < 0.05) along with a higher number of 90-day-readmissions (0.65 vs. 0.15, p < 0.05), and patients with atrial fibrillation had significantly longer postoperative ICU stays (3.2 vs. 1.6, p < 0.05). No other patient comorbidities were found to significantly impact functional outcomes. Regarding patient-reported questionnaires, PROMIS-29 scores were found to be significantly higher in patients with anxiety (10.0 vs. 9.2, p< 0.01) and depression (10.4 vs. 8.9, p< 0.001). Further, postoperative ODI scores were also elevated in patients with anxiety (40.05 vs. 32.87, p< 0.05) and depression (40.19 vs. 31.88, p< 0.01). Finally, smoking status was predictive of higher postoperative VAS scores (3.4 vs. 2.9, p < 0.01).

Conclusion : This study supports the importance of effective management of patient comorbidities in achieving positive outcomes following deformity correction surgery. Further, comorbid mental health disorders should be considered in the interpretation of patient-reported outcome questionnaires.