Brian J Neuman1, Tamir Ailon2, Justin K Scheer3, Eric Klineberg4, Daniel M Sciubba5, Amit Jain1, Lukas P Zebala6, Peter G Passias7, Alan H Daniels8, Douglas C Burton9, Themi S Protopsaltis7, D Kojo Hamilton10, Christopher P Ames11. 1. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland. 2. Department of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada. 3. University of California San Diego School of Medicine, San Diego, California. 4. Department of Orthopaedics, University of California Davis School of Medicine, Sacramento, California. 5. Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland. 6. Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri. 7. Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, New York. 8. Department of Ortho-paedic Surgery, Brown University Alpert Medical School, Rhode Island Hospital, Providence, Rhode Island. 9. Department of Orthopaedic Surgery, University of Kansas, Kansas City, Kansas. 10. Department of Neurological Surgery, University of Pittsburgh School of Medi-cine, Pittsburgh, Pennsylvania. 11. Depart-ment of Neurosurgery, University of California San Francisco, San Francisco, California.
Abstract
BACKGROUND: A surgical invasiveness index (SII) has been validated in general spine procedures but not adult spinal deformity (ASD). OBJECTIVE: To assess the ability of the SII to determine the invasiveness of ASD surgery and to create and validate a novel ASD index incorporating deformity-specific factors, which could serve as a standardized metric to compare outcomes and risk stratification of different ASD procedures for a given deformity. METHODS: Four hundred sixty-four patients who underwent ASD surgery between 2009 and 2012 were identified in 2 multicenter prospective registries. Multivariable models of estimated blood loss (EBL) and operative time were created using deformity-specific factors. Beta coefficients derived from these models were used to attribute points to each component. Scoring was iteratively refined to determine the R2 value of multivariate models of EBL and operative time using adult spinal deformity-surgical (ASD-S) as an independent variable. Similarly, we determined weighting of postoperative changes in radiographical parameters, which were incorporated into another index (adult spinal deformity-surgical and radiographical [ASD-SR]). The ability of these models to predict surgical invasiveness was assessed in a validation cohort. RESULTS: Each index was a significant, independent predictor of EBL and operative time (P < .001). On multivariate analysis, ASD-S and ASD-SR explained more variability in EBL and operative time than did the SII (P < .001). The ASD-SR explained 21% of the variation in EBL and 10% of the variation in operative time, whereas the SII explained 17% and 3.2%, respectively. CONCLUSION: The ASD-SR, which incorporates deformity-specific components, more accurately predicts the magnitude of ASD surgery than does the SII.
BACKGROUND: A surgical invasiveness index (SII) has been validated in general spine procedures but not adult spinal deformity (ASD). OBJECTIVE: To assess the ability of the SII to determine the invasiveness of ASD surgery and to create and validate a novel ASD index incorporating deformity-specific factors, which could serve as a standardized metric to compare outcomes and risk stratification of different ASD procedures for a given deformity. METHODS: Four hundred sixty-four patients who underwent ASD surgery between 2009 and 2012 were identified in 2 multicenter prospective registries. Multivariable models of estimated blood loss (EBL) and operative time were created using deformity-specific factors. Beta coefficients derived from these models were used to attribute points to each component. Scoring was iteratively refined to determine the R2 value of multivariate models of EBL and operative time using adult spinal deformity-surgical (ASD-S) as an independent variable. Similarly, we determined weighting of postoperative changes in radiographical parameters, which were incorporated into another index (adult spinal deformity-surgical and radiographical [ASD-SR]). The ability of these models to predict surgical invasiveness was assessed in a validation cohort. RESULTS: Each index was a significant, independent predictor of EBL and operative time (P < .001). On multivariate analysis, ASD-S and ASD-SR explained more variability in EBL and operative time than did the SII (P < .001). The ASD-SR explained 21% of the variation in EBL and 10% of the variation in operative time, whereas the SII explained 17% and 3.2%, respectively. CONCLUSION: The ASD-SR, which incorporates deformity-specific components, more accurately predicts the magnitude of ASD surgery than does the SII.
Authors: Justin S Smith; Christopher I Shaffrey; Michael P Kelly; Elizabeth L Yanik; Jon D Lurie; Christine R Baldus; Charles Edwards; Steven D Glassman; Lawrence G Lenke; Oheneba Boachie-Adjei; Jacob M Buchowski; Leah Y Carreon; Charles H Crawford; Thomas J Errico; Stephen J Lewis; Tyler Koski; Stefan Parent; Han Jo Kim; Christopher P Ames; Shay Bess; Frank J Schwab; Keith H Bridwell Journal: Spine (Phila Pa 1976) Date: 2019-09-01 Impact factor: 3.241
Authors: Francis Lovecchio; Michael Steinhaus; Jonathan Charles Elysee; Alex Huang; Bryan Ang; Renaud Lafage; Jingyan Yang; Ellen Soffin; Chad Craig; Virginie Lafage; Frank Schwab; Han Jo Kim Journal: Global Spine J Date: 2020-08-13
Authors: Rafael De la Garza Ramos; Jonathan Nakhla; Murray Echt; Yaroslav Gelfand; Aleka N Scoco; Merrit D Kinon; Reza Yassari Journal: Global Spine J Date: 2018-04-26
Authors: Elie Massaad; Nida Fatima; Muhamed Hadzipasic; Christopher Alvarez-Breckenridge; Ganesh M Shankar; John H Shin Journal: Neurospine Date: 2019-12-31
Authors: Daniel Sciubba; Amit Jain; Khaled M Kebaish; Brian J Neuman; Alan H Daniels; Peter G Passias; Han J Kim; Themistocles S Protopsaltis; Justin K Scheer; Justin S Smith; Kojo Hamilton; Shay Bess; Eric O Klineberg; Christopher P Ames Journal: Global Spine J Date: 2019-12-26