P10. Anterior versus non-anterior approach in adult spinal deformity surgery: a propensity-score matched analysis using NSQIP data

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100634

Ankit Indravadan Mehta MD , Kaho Adachi BA , Adith Srivatsa BS , Morteza Sadeh MD, PhD

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引用次数: 0

Abstract

BACKGROUND CONTEXT

Surgical interventions for adult spine deformity (ASD) are often required after failed conservative treatment or in cases of spinal decompensation; however, these procedures are associated with high morbidity. Traditionally, the posterior approach has been the standard, but the anterior approach has gained popularity due to its mechanical and biological advantages. Nevertheless, available studies are limited by small sample sizes and report conflicting outcomes when comparing these two approaches.

PURPOSE

Our study aims to compare procedures with anterior (anterior group) and without anterior (non-anterior group) approaches for ASD and identify complication rates and hospital outcomes.

STUDY DESIGN/SETTING

Retrospective cohort study using propensity-matched analysis.

PATIENT SAMPLE

Patients 18 years and older with ASD who underwent spinal deformity correction surgery.

OUTCOME MEASURES

The primary outcome was 30-day postoperative complications. The secondary outcomes were procedural time, length of hospital stay, and rates of readmission and reoperation. Subgroup analysis included procedural detail for scoliosis.

METHODS

The National Surgical Quality Improvement Program was queried from 2015 to 2023 for patients 18 years and older with ASD who underwent spinal deformity correction surgery. The patients in the anterior group were propensity-matched with the non-anterior group based on demographic, procedural detail, and comorbid conditions to identify hospital complications and outcomes (p < 0.05). Descriptive statistics were used to perform a subgroup analysis of patients with scoliosis.

RESULTS

There were 389 patients in the anterior and 2,774 in the non-anterior groups. The anterior group had older patients with increased weight (p < 0.001). Smoking (p < 0.01), diabetes mellitus (p = 0.04), and hypertension (p = 0.01) were more prevalent in the anterior group while COPD (p = 0.02) was more frequent in the non-anterior group. The lumbar spine was the most operated region for both groups (31.62% and 19.75% respectively). For hospital complications, the non-anterior group had a higher rate of surgical site infection (SSI) (p=0.01) while unplanned intubation was more prevalent in the anterior group (0.03). The anterior group had a significantly shorter operative time (p=0.01) while hospital stay (p=0.53), reoperation rate (p=0.38), and readmission rate (p=0.57) were similar between the two groups. In the subgroup analysis focusing on scoliosis, the thoracolumbar region was the most operated in the non-anterior group (43.6%), while the lumbar region was the most operated in the anterior group (51.9%).

CONCLUSIONS

Our study found that the anterior approach was associated with a shorter operative time and a higher intubation rate, while SSI was more commonly observed in the non-anterior approach. The lumbar region was the most frequently operated spine region overall. Both approaches were generally safe, with a trend favoring the anterior approach for patients with higher body weight. These findings can guide clinicians in selecting the optimal approach for deformity correction surgery.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.

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P10。成人脊柱畸形手术前路与非前路入路：使用NSQIP数据进行倾向评分匹配分析

背景：成人脊柱畸形（ASD）在保守治疗失败或脊柱失代偿后通常需要手术干预；然而，这些手术与高发病率有关。传统上，后路入路是标准的，但由于其机械和生物学上的优势，前路入路越来越受欢迎。然而，现有的研究受到样本量小的限制，在比较这两种方法时报告的结果相互矛盾。目的：本研究旨在比较采用前路（前路组）和不采用前路（非前路组）入路治疗ASD的方法，并确定并发症发生率和医院预后。研究设计/设置采用倾向匹配分析的回顾性队列研究。患者样本：18岁及以上接受脊柱畸形矫正手术的ASD患者。主要终点是30天的术后并发症。次要结果为手术时间、住院时间、再入院率和再手术率。亚组分析包括脊柱侧凸的手术细节。方法对2015年至2023年接受脊柱畸形矫正手术的18岁及以上ASD患者进行国家外科质量改进计划的查询。基于人口统计学、手术细节和合并症，前路组患者与非前路组患者倾向匹配，以确定医院并发症和预后(p <；0.05)。描述性统计用于对脊柱侧凸患者进行亚组分析。结果前路组389例，非前路组2774例。前路组有体重增加的老年患者(p <；0.001)。吸烟(p <；糖尿病（p = 0.04）和高血压（p = 0.01）在前路组更常见，而COPD （p = 0.02）在非前路组更常见。腰椎是两组手术最多的部位（分别占31.62%和19.75%）。对于医院并发症，非前路组手术部位感染（SSI）发生率较高（p=0.01），而非计划插管组发生率较高（p= 0.03）。前路组手术时间明显缩短（p=0.01），两组住院时间（p=0.53）、再手术率（p=0.38）、再入院率（p=0.57）相似。在聚焦脊柱侧凸的亚组分析中，非前路手术组中胸腰椎手术最多（43.6%），前路手术组中腰椎手术最多（51.9%）。结论我们的研究发现，前路入路手术时间较短，插管率较高，而非前路入路更常见SSI。腰椎是手术最频繁的脊柱区域。两种入路通常都是安全的，对于体重较高的患者，倾向于前路入路。这些发现可以指导临床医生选择最佳的畸形矫正手术入路。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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