Researchers conducted a cohort study with a retrospective design. They sought to evaluate the risk variables for revision surgery in patients who had primary adult spinal deformity (ASD) surgery within 2 years. From 2007 to 2015, the authors searched the MarketScan database for individuals diagnosed with a spinal abnormality and who had ASD surgery. Researchers studied Patient-level variables and revision risk during the 2 years following the original ASD surgery. Patients under 18 and those with a history of trauma or malignancy were not allowed to participate in the study. The data set included 7,422 patients who underwent ASD surgery between 2007 and 2015. At 90 days, the revision rate was 13.1%, 14.5% at 6 months, 16.7% at a year, and 19.3% at 2 years. Obesity [adjusted odds ratio (OR): 1.58, P<0.001] and cigarette smoking (adjusted OR: 1.38, P=0.0011) were linked to an increased risk of reoperation within 2 years in a multivariate multiple logistic regression analysis. Patients who underwent a hybrid anterior-posterior approach had a decreased risk of reoperation (adjusted OR: 0.66, P=0.0117) than those who experienced a posterior-only process. Obesity and smoking were linked to a higher risk of revision surgery within 2 years of the first ASD surgery. The male gender and a combined surgical strategy were linked to a lower risk of revision surgery.