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Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery.

Publication ,  Journal Article
Neuman, BJ; Harris, AB; Klineberg, EO; Hostin, RA; Protopsaltis, TS; Passias, PG; Gum, JL; Hart, RA; Kelly, MP; Daniels, AH; Ames, CP ...
Published in: Spine
July 2021

Retrospective review.The aim of this study was to define a surgical invasiveness threshold that predicts major complications after adult spinal deformity (ASD) surgery; use this threshold to categorize patients into quartiles by invasiveness; and determine the odds of major complications by quartile.Understanding the relationship between surgical invasiveness and major complications is important for estimating the likelihood of major complications after ASD surgery.Using a multicenter database, we identified 574 ASD patients (more than 5 levels fused; mean age, 60 ± 15 years) with minimum 2-year follow-up. Invasiveness was calculated as the ASD Surgical and Radiographic (ASD-SR) score. Youden index was used to identify the invasiveness score cut-off associated with optimal sensitivity and specificity for predicting major complications. Resulting high- and low-invasiveness groups were divided in half to create quartiles. Odds of developing a major complication were analyzed for each quartile using logistic regression (alpha = 0.05).The ASD-SR cutoff score that maximally predicted major complications was 90 points. ASD-SR quartiles were 0 to 65 (Q1), 66 to 89 (Q2), 90 to 119 (Q3), and ≥120 (Q4). Risk of a major complication was 17% in Q1, 21% in Q2, 35% in Q3, and 33% in Q4 (P < 0.001). Comparisons of adjacent quartiles showed an increase in the odds of a major complication from Q2 to Q3 (odds ratio [OR] 1.8; 95% confidence interval [CI]: 1.0-3.0), but not from Q1 to Q2 or from Q3 to Q4. Patients with ASD-SR scores ≥90 were 1.9 times as likely to have a major complication than patients with scores <90 (OR 1.9, 95% CI 1.3-2.9). Mean ASD-SR scores above and below 90 points were 121 ± 25 and 63 ± 17, respectively.The odds of major complications after ASD surgery are significantly greater when the procedure has an ASD-SR score ≥90. ASD-SR score can be used to counsel patients regarding these increased odds.Level of Evidence: 3.

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Published In

Spine

DOI

EISSN

1528-1159

ISSN

0362-2436

Publication Date

July 2021

Volume

46

Issue

14

Start / End Page

931 / 938

Related Subject Headings

  • Spine
  • Spinal Diseases
  • Retrospective Studies
  • Postoperative Complications
  • Orthopedics
  • Orthopedic Procedures
  • Middle Aged
  • Humans
  • Aged
  • 4201 Allied health and rehabilitation science
 

Citation

APA
Chicago
ICMJE
MLA
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Neuman, B. J., Harris, A. B., Klineberg, E. O., Hostin, R. A., Protopsaltis, T. S., Passias, P. G., … and the International Spine Study Group, . (2021). Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery. Spine, 46(14), 931–938. https://doi.org/10.1097/brs.0000000000003949
Neuman, Brian J., Andrew B. Harris, Eric O. Klineberg, Richard A. Hostin, Themistocles S. Protopsaltis, Peter G. Passias, Jeffrey L. Gum, et al. “Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery.Spine 46, no. 14 (July 2021): 931–38. https://doi.org/10.1097/brs.0000000000003949.
Neuman BJ, Harris AB, Klineberg EO, Hostin RA, Protopsaltis TS, Passias PG, et al. Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery. Spine. 2021 Jul;46(14):931–8.
Neuman, Brian J., et al. “Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery.Spine, vol. 46, no. 14, July 2021, pp. 931–38. Epmc, doi:10.1097/brs.0000000000003949.
Neuman BJ, Harris AB, Klineberg EO, Hostin RA, Protopsaltis TS, Passias PG, Gum JL, Hart RA, Kelly MP, Daniels AH, Ames CP, Shaffrey CI, Kebaish KM, and the International Spine Study Group. Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery. Spine. 2021 Jul;46(14):931–938.

Published In

Spine

DOI

EISSN

1528-1159

ISSN

0362-2436

Publication Date

July 2021

Volume

46

Issue

14

Start / End Page

931 / 938

Related Subject Headings

  • Spine
  • Spinal Diseases
  • Retrospective Studies
  • Postoperative Complications
  • Orthopedics
  • Orthopedic Procedures
  • Middle Aged
  • Humans
  • Aged
  • 4201 Allied health and rehabilitation science