Ferran Pellisé1, Miquel Serra-Burriel2, Justin S Smith3, Sleiman Haddad1, Michael P Kelly4, Alba Vila-Casademunt5, Francisco Javier Sánchez Pérez-Grueso6, Shay Bess7, Jeffrey L Gum8, Douglas C Burton9, Emre Acaroğlu10, Frank Kleinstück11, Virginie Lafage12, Ibrahim Obeid13, Frank Schwab12, Christopher I Shaffrey3, Ahmet Alanay14, Christopher Ames15. 1. 1Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain. 2. 2Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain. 3. 3Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia. 4. 4Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri. 5. 5Spine Research Unit, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain. 6. 6Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain. 7. 7Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado. 8. 8Norton Leatherman Spine Center, Louisville, Kentucky. 9. 9Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas. 10. 10Ankara ARTES Spine Center, Ankara, Turkey. 11. 11Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Zürich, Switzerland. 12. 12Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. 13. 13Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France. 14. 14Department of Orthopedics and Traumatology, Acıbadem University, Istanbul, Turkey; and. 15. 15Department of Neurosurgery, University of California, San Francisco, California.
Abstract
OBJECTIVE: Adult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO). METHODS: Two models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASD patients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis. RESULTS: The final sample consisted of 1612 ASD patients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%-75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs. CONCLUSIONS: The creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.
OBJECTIVE: Adult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO). METHODS: Two models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASDpatients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis. RESULTS: The final sample consisted of 1612 ASDpatients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%-75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs. CONCLUSIONS: The creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.
Entities:
Keywords:
ACS NSQIP = American College of Surgeons National Surgical Quality Improvement Program; ASD = adult spinal deformity; EBL = estimated blood loss; LIV = lowest instrumented vertebra; MC = major complication; ODI = Oswestry Disability Index; OOB = out of bag; PROM = patient-reported outcome measure; RA = readmission; RO = reoperation; SF-36 = SF-36v2 Health Survey; SRS-22r = Scoliosis Research Society 22-item patient outcome questionnaire; adult spinal deformity surgery; prognostic models; risk stratification
Authors: Ferran Pellisé; Alba Vila-Casademunt; Susana Núñez-Pereira; Sleiman Haddad; Justin S Smith; Michael P Kelly; Ahmet Alanay; Christopher Shaffrey; Javier Pizones; Çaglar Yilgor; Ibrahim Obeid; Douglas Burton; Frank Kleinstück; Tamas Fekete; Shay Bess; Munish Gupta; Markus Loibl; Eric O Klineberg; Francisco J Sánchez Pérez-Grueso; Miquel Serra-Burriel; Christopher P Ames Journal: Eur Spine J Date: 2022-03-28 Impact factor: 2.721
Authors: Rushikesh S Joshi; Darryl Lau; Justin K Scheer; Miquel Serra-Burriel; Alba Vila-Casademunt; Shay Bess; Justin S Smith; Ferran Pellise; Christopher P Ames Journal: Spine Deform Date: 2021-05-18