Development and validation of risk stratification models for adult spinal deformity surgery.

Pellisé, Ferran

Serra-Burriel, Miquel

Smith, Justin S

Haddad, Sleiman

Kelly, Michael P

Vila-Casademunt, Alba

Sánchez Pérez-Grueso, Francisco Javier

Bess, Shay

Gum, Jeffrey L

Burton, Douglas C

Acaroğlu, Emre

Kleinstück, Frank

Lafage, Virginie

Obeid, Ibrahim

Schwab, Frank

Shaffrey, Christopher I

Alanay, Ahmet

Ames, Christopher

International Spine Study Group

European Spine Study Group

2023-06-20T13:18:00Z

2023-06-20T13:18:00Z

2019-06

2023-06-20T13:17:53Z

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.

2019.3.SPINE181452

1547-5654

1547-5646

https://hdl.handle.net/10161/28200

eng

Journal of Neurosurgery Publishing Group (JNSPG)

Journal of neurosurgery. Spine

10.3171/2019.3.spine181452

International Spine Study Group

European Spine Study Group

Development and validation of risk stratification models for adult spinal deformity surgery.

Journal article

Shaffrey, Christopher I|0000-0001-9760-8386

1

13

4

Duke

School of Medicine

Clinical Science Departments

Orthopaedic Surgery

Neurosurgery

Published

31