Decision analysis to identify the ideal treatment for adult spinal deformity: What is the impact of complications on treatment outcomes?

Abstract

Objective: The aim of this study was to analyze the impact of treatment complications on outcomes inadult spinal deformity (ASD) using a decision analysis (DA) model.Methods: The study included 535 ASD patients (371 with non-surgical (NS) and 164 with surgical (S)treatment) from an international multicentre database of ASD patients. DA was structured in two mainsteps; 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference-utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as lifethreatening (LT) and nonlife threatening (NLT) and their probabilities were calculated from the databaseas well as a thorough literature review. Outcomes were analyzed as improvement, no change anddeterioration. Death/complete paralysis was considered as a separate category.Results: All 535 patients were analyzed in regard to complications. Overall, there were 78 NLT and 12 LTcomplications and 3 death/paralysis. Surgical treatment offered signiŞcantly higher chances of clinicalimprovement but also was signiŞcantly more prone to complications (31.7% vs. 11.1%, p < 0.001).Conclusion: Surgical treatment of ASD is more likely to cause complications compared to NS treatment.On the other hand, surgery has been shown to provide a higher likelihood of improvement in HRQoLscores. So, the decision on the type of treatment in ASD needs to take both chances of improvement andburden associated with S or NS treatments and better be arrived by the active participation of patientsand physicians equipped with the present information.Level of evidence: Level II, Decision analysis.© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)