Evidence map›Paper›PMID 37685633›Full record

ArticleJournal of clinical medicine2023

Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery.

Peter G Passias, Tyler K Williamson, Jamshaid M Mir, Justin S Smith, Virginie Lafage, Renaud Lafage, Breton Line, Alan H Daniels, Jeffrey L Gum, Andrew J Schoenfeld and 18 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Peter G PassiasDepartments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, NY 10003, USA.ORCID 0000-0002-1479-4070
Tyler K WilliamsonDepartments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, NY 10003, USA.ORCID 0000-0003-2584-291X
Jamshaid M MirDepartments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, New York, NY 10003, USA.ORCID 0000-0003-3032-3225
Justin S SmithDepartment of Neurosurgery, University of Virginia, Charlottesville, VA 22904, USA.
Virginie LafageDepartment of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA.ORCID 0000-0002-0119-7111
Renaud LafageDepartment of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, USA.
Breton LineDepartment of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO 80205, USA.ORCID 0000-0003-0395-1066
Alan H DanielsDepartment of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA.
Jeffrey L GumDepartment of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, KY 40202, USA.
Andrew J SchoenfeldDepartment of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA 02120, USA.
David Kojo HamiltonDepartments of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Alex SoroceanuDepartment of Orthopaedic Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada.
Justin K ScheerDepartment of Neurosurgery, University of California, San Francisco, CA 94143, USA.
Robert EastlackDivision of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA.
Gregory M MundisDivision of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA.
Bassel DieboDepartment of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA.
Khaled M KebaishDepartment of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
Richard A HostinDepartment of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX 75243, USA.
Munish C GuptaDepartment of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02912, USA.
Han Jo KimDepartment of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, USA.
Eric O KlinebergDepartment of Orthopedic Surgery, University of California Davis, Sacramento, CA 95819, USA.
Christopher P AmesDepartment of Neurosurgery, University of California, San Francisco, CA 94143, USA.
Robert A HartDepartment of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA 98122, USA.
Douglas C BurtonDepartment of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Frank J SchwabDepartment of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA.
Christopher I ShaffreySpine Division, Departments of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
Shay BessDepartment of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO 80205, USA.
On Behalf Of The International Spine Study GroupRocky Mountain Scoliosis and Spine, Denver, CO 80124, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhile reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications.

objectiveCompare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. STUDY DESIGN/

settingRetrospective cohort study of a prospectively collected multicenter database.

methodsASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility.

resultsA total of 930 patients were considered. Following PSM, 253 "optimal" (O) and 253 "not optimal" (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%,

conclusionsFewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success.

Indexed as

adult spinal deformityclinical improvementcomplex realignmentcomplicationscost-utilityMedicare

Identifiers

PMID37685633
PMCPMC10488913

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.