Adult Spinal Deformity: National Trends in the Presentation, Treatment, and Perioperative Outcomes From 2003 to 2010

Peter G. Passias, Cyrus M. Jalai, Nancy Worley, Shaleen Vira, Bryan Marascalchi, Shearwood McClelland, Virginie Lafage, Thomas J. Errico

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Study Design Retrospective review of a prospective database. Objectives To investigate adult spinal deformity (ASD) surgery outcome trends on a nationwide scale using the Nationwide Inpatient Sample (NIS) from 2003 to 2010. Methods ASD patients ≥25 years from 2003 to 2010 in the NIS undergoing anterior, posterior, or combined surgical approaches were included. Fractures, 9+ levels fused, or any cancer were excluded. Patient demographics, hospital data, and procedure-related complications were evaluated. Yearly trends were analyzed using univariate analysis and linear regression modeling. Results Of 10,966 discharges, 1,952 were anterior, 6,524 were posterior, and 1,106 were combined. The total surgical ASD volume increased by 112.5% (p =.029), and both the average patient age (p <.001) and number of patients >65 years old significantly increased from 2003 to 2010 (p =.009). Anterior approach case volume decreased by 13.7% (p =.019), whereas that of combined increased by 22.7% (p =.047). Posterior case volume increased by 38.9% from 2003 to 2010, though insignificantly (p =.084). Total hospital charges for all approaches increased over the interval (p <.001). Total length of stay for all approaches decreased over the time interval (p <.005). Although the overall morbidity for all approaches increased by 22.7% (p <.001), mortality did not change (p =.817). The most common morbidities in 2003 were hemorrhagic anemia, accidental cut, puncture, perforation, or laceration during a procedure, and device-related complications, which persisted in 2010 with the exception of increased acute respiratory distress syndrome and pulmonary-related complications. Conclusions For ASD surgery from 2003 to 2010, the volume of anterior approaches decreased, whereas posterior procedures did not change, and combined approaches increased. Total hospital charges increased for all considered procedures, length of hospital stay decreased, whereas operative patients were increasingly elderly, and more procedures were observed for patients >65 years old. For all approaches, morbidity increased whereas mortality did not change. Future study is required to develop methods to reduce morbidity and costs, thereby optimizing patient outcomes.

Original languageEnglish (US)
Pages (from-to)342-350
Number of pages9
JournalSpine deformity
Issue number5
StatePublished - Sep 2017
Externally publishedYes


  • Adult spinal deformity
  • Hospital characteristics
  • Morbidity
  • Mortality
  • National trends

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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