1068 Is Rheumatoid Arthritis Associated With Worse Outcomes Following Adult Spinal Deformity Surgery?

INTRODUCTION: Patients with rheumatoid arthritis (RA) undergoing adult spinal deformity (ASD) surgery achieve worse postoperative outcomes compared to patients without RA. METHODS: A single-institution, retrospective cohort study was performed of patients with RA undergoing ASD surgery from 2009-21. Multivariable regression analysis controlled for age, BMI, T-score, and preoperative SVA/T1PA. RESULTS: Among 238 patients undergoing ASD surgery, 34(14.3%) had RA, for a mean of 9.6±4.4years prior to surgery. Ten (29.4%) were on steroids and 14(41.2%) on DMARDs. RA patients were more likely to have 2 or more comorbidities (73.5%vs.35.3%, p<0.001), lower L1-S1 lordosis (-8.7±36.1ºvs.-25.3±31.7º, p=0.006), and worse ODI (54.8±10.70vs.48.9±12.8, p=0.037). They had more mechanical complications (85.3%vs.57.4%, p=0.002), mechanical complications requiring reoperation (58.8%vs.29.4%, p=0.001), proximal junctional kyphosis and failure (PJK/F) (76.5%vs.42.6%, p<0.001), PJK/F requiring reoperation (50.0%vs.13.7%, p<0.001), spinopelvic complications (20.6%vs.6.4%, p=0.006), and rod fracture/pseudarthrosis (50.0%vs.29.4%, p=0.018). On multivariable regression, RA independently predicted mechanical complications requiring reoperation (OR=2.80), PJK/F (OR=4.28) and PJK/F requiring reoperation (OR=7.38). DMARD use was associated with less mechanical complications requiring reoperation (28.6%vs.80%, p=.003). Years of RA diagnosis (p=0.134) or being on steroids (p=.150) had no association with outcomes. CONCLUSIONS: In RA patients undergoing ASD surgery, 85% suffered a mechanical complication and 59% required reoperation. RA patients had more comorbidities, worse baseline disability, and worse preoperative/postoperative alignment. RA was independently associated with reoperation for a mechanical complication and PJK/F. DMARD use decreased the risk of mechanical complications and reoperation.