# Patient-Reported Outcomes After Adult Spinal Deformity Surgery: Are There Differences Between Primary and Revision Surgery?

## TL;DR

This study found no difference in patient satisfaction or quality of life between primary and revision spinal surgery for adult spinal deformity.

## Contribution

The study provides evidence that patient satisfaction is comparable between primary and revision adult spinal deformity surgeries.

## Key findings

- Median satisfaction scores were similar between revision and primary surgery groups.
- There was no statistically significant difference in HRQoL outcomes between the two groups.
- Patients undergoing revision surgery reported comparable satisfaction despite higher complication risks.

## Abstract

Background: Surgical treatment of adult spinal deformity (ASD) can significantly improve health-related quality of life (HRQoL) but is associated with a high revision rate. Whether the same patient satisfaction can be expected after revision surgery compared to primary surgery is uncertain.

Purpose: This study aimed to compare patient satisfaction between revision and primary ASD surgery.

Methods: We conducted a retrospective study on patients with ASD undergoing primary or revision surgery on ≥ five levels. We included adult patients from a single center between 2010 and 2020 who had completed ≥two-year-postoperative HRQoL questionnaires. Patients were divided into two groups: primary surgery and revision surgery. Health-related quality of life and treatment satisfaction were assessed with the Scoliosis Research Society Patient Outcome Questionnaire (SRS-22r) and the European Quality of Life (EQ-5D-3L) questionnaires and compared between groups.

Results: A total of 185 patients completed the postoperative questionnaires (97 primary surgery; 88 revision surgery). The mean age was 59.8±16.1 years in the revision group and 50.7±20.4 in the primary group (p<0.001). The median satisfaction score was 4.0 (3.0-4.5) in the revision group and 4.0 (3.5-4.6) in the primary group (p=0.096). The median SRS-22r subscore was 3.0 (2.4-3.6) vs. 3.3 (2.5-3.9) (p=0.087). The EQ-5D-3L index score was 0.37 (0.30-0.53) vs. 0.42 (0.30-0.63) (p=0.106) for the revision surgery group and primary surgery group, respectively.

Conclusion: We found no difference in overall patient-reported HRQoL and treatment satisfaction between revision and primary surgery. Although revision surgery is associated with increased morbidity and risk of complications, patients can expect the same patient satisfaction compared to their primary surgery in the absence of complications.