177. Would you do it again? Discrepancies between patient and surgeon willingness for adult spine deformity surgery

BACKGROUND CONTEXT ASD surgery is associated with postoperative improvements in patient pain and function but is also associated with high complication rates and long recovery. Accordingly, if given a choice, patients may indicate they would not undergo surgery again. PURPOSE At minimum two years postop, evaluate 1) surgically treated ASD patients for willingness to receive/not receive the same surgery, 2) surgeon willingness to perform/not perform the same surgery, 3) surgeon opinion if the corresponding patient would indicate they would/would not have the same surgery again. STUDY DESIGN/SETTING Analysis of patient vs surgeon willingness to perform/receive surgery for ASD patients enrolled into a prospective, multicenter study. PATIENT SAMPLE Surgically treated ASD patients prospectively enrolled into multicenter study. OUTCOME MEASURES Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), estimated blood loss, duration of hospital stay, postoperative complications, revision spine surgery, patient and surgeon willingness to perform surgery. Methods Surgically treated ASD patients, prospectively enrolled into a multicenter study from 2009-2018, were asked at minimum 2 years postop, using SRS-22r question 22 if, based upon their surgical and recovery experience, they would undergo the same surgery. Surgeons were matched to their corresponding patients and the surgeons asked if 1) surgeon would perform the same surgery on the patient and why/why not, 2) surgeon believed the patient would undergo the same surgery and why/why not. Patients were divided into those that indicated they would (yes) or not (no) have same surgery. Agreement between patient and surgeon willingness for same surgery was assessed and correlations between willingness for same surgery and postop complications, deformity improvement, and PROMs evaluated. Results Of 961 patients eligible for study, 580 were evaluated. The no group (n=108, 18.6%) had similar levels fused, osteotomies, duration of hospital and SICU stay, and major complications as the yes group. (n=472; 81.4%; p>0.05). No group members were younger (58.5 vs 61.6 years), more frail (ASD frailty scale 3.9 vs 3.3), and at minimum 2-years postop had more complications requiring surgery and worse postop improvements for all PROMs including ODI (3.8 vs 18.9), SF-36 PCS (1.8 vs 10) and SRS-22r total (0.4 vs 0.9), pain (0.5 vs 1.2), activity (0.2 vs0.7), and self-image (0.6 vs 1.3) than the yes group, respectively (p Conclusions ASD patient willingness to undergo same surgery is important for counseling. Unwillingness for same surgery was associated with PROMs, MCID and complications requiring surgery. Surgeons were poorly able to identify patients unwilling to undergo the same surgery. More research is needed to understand patient experiences recovering from ASD surgeries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.