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Research ArticleCase Report

Case Start Timing of Adult Spinal Deformity Surgeries: Does the Wait Matter?

Michael Dinizo, Karan Patel, Igor Dolgalev, Peter G. Passias, Thomas J. Errico and Tina Raman
International Journal of Spine Surgery February 2022, 8172; DOI: https://doi.org/10.14444/8172
Michael Dinizo
1 Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Karan Patel
1 Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Igor Dolgalev
2 Applied Bioinformatics Laboratory, NYU Langone Medical Center, Miami, FL
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Peter G. Passias
1 Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Thomas J. Errico
3 Nicklaus Childrens Hospital, Miami, FL
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Tina Raman
1 Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Article Figures & Data

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    Table 1

    Characteristics of 1040 adults who underwent surgery for spinal deformity.

    CharacteristicEarly Start (N = 771)Late Start (N = 269) P Value (Early vs Late Start)
    n (%)Mean ± SD n (%)Mean ± SD
    Age, y 44 ± 24 50 ± 220.10
    BMI 25 ± 6 26 ± 70.52
    ASA classification 2.4 ± 0.6 2.5 ± 0.60.14
    mFI 0.4 ± 0.7 0.5 ± 0.70.10
    Female sex454 (59) 183 (68) 0.82
    Comorbidities     
     Diabetes mellitus57 (7.4) 23 (8.6) 0.98
     COPD29 (3.8) 19 (7.1) 0.09
     Cardiovascular disease188 (24) 90 (34) 0.10
     Osteoporosis50 (6.5) 19 (7.1) 0.80
    • ASA, American Society of Anesthesiologists; BMI, body mass index; COPD, chronic obstructive pulmonary disease; mFI, modified frailty index.

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    Table 2

    Surgical characteristics of 1040 adults who underwent surgery for spinal deformity.

    CharacteristicEarly Start (N = 771)Late Start (N = 269) P Value (Early vs Late Start)
    n (%)Mean ± SD n (%)Mean ± SD
    Mirza invasiveness index21 ± 8.219.8 ± 8.80.04
    Number of levels fused10.4 ± 4.09.6 ± 4.40.01
    Operative time (h)6.9 ± 3.76.5 ± 3.00.12
    3-Column osteotomy88 (11)37 (14)0.85
    Posterior column osteotomy284 (37)125 (46)0.31
    TLIF192 (25)96 (36)0.04
    ALIF26 (3.4)8 (3.0)0.48
    Multirod (<2) configuration451 (58)167 (62)0.19
    Estimated blood loss (mL)1721 ± 15961466 ± 12970.16
    Length of hospital stay (d)6.5 ± 3.86.8 ± 3.90.20
    • ALIF, anterior lumbar interbody fusion; TLIF, transforaminal lumbar interbody fusion.

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    Table 3

    Complication and readmission/unplanned reoperation rates in early start vs late start cases.

    ParameterEarly Start (N = 771)Late Start (N = 269) P Value
    (Early vs Late Start)
    n % n %
    90-d readmission  466.03011.20.02
    90-d unplanned reoperation516.63412.60.008
    Neurologic complications
     Postoperative new onset radiculopathy70.993.30.007
     Residual central or foraminal stenosis with persistent radiculopathy50.662.20.029
    • View popup
    Table 4

    Impact of late start time on readmission/unplanned reoperation rates.

    Parameter β Coefficient (95% CI) P Value
    90-d readmission1.8 (1.1–3.0)0.02
    Unplanned reoperation1.9 (1.2–3.1)0.009
    Neurologic complication2.1 (1.0–4.3)0.046
    • View popup
    Table 5

    Complications in early start vs late start cases.

    ParameterEarly Start (N = 771)Late Start (N = 269) P Value
    n % n %
    Overall number of complications719.22810.40.56
    Instrumentation-related complication131.783.00.20
    Postoperative cerebrospinal fluid leak111.441.50.94
    Wound infection70.962.20.09
    Seroma202.6103.70.34
    Pulmonary embolism60.851.90.14
    Deep venous thrombosis50.631.10.45
    Postoperative pneumonia81.2000.09
    Ileus101.341.50.82
    Postoperative urinary retention131.710.40.11
    Sacral fracture20.3000.40
    Delirium50.620.70.87
    Epidural hematoma10.110.40.44
    Mortality20.320.70.27
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Case Start Timing of Adult Spinal Deformity Surgeries: Does the Wait Matter?
Michael Dinizo, Karan Patel, Igor Dolgalev, Peter G. Passias, Thomas J. Errico, Tina Raman
International Journal of Spine Surgery Feb 2022, 8172; DOI: 10.14444/8172

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Case Start Timing of Adult Spinal Deformity Surgeries: Does the Wait Matter?
Michael Dinizo, Karan Patel, Igor Dolgalev, Peter G. Passias, Thomas J. Errico, Tina Raman
International Journal of Spine Surgery Feb 2022, 8172; DOI: 10.14444/8172
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