Predictive Analytics for Determining Extended Operative Time in Corrective Adult Spinal Deformity Surgery.

dc.contributor.author

Passias, Peter G

dc.contributor.author

Poorman, Gregory W

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Vasquez-Montes, Dennis

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Kummer, Nicholas

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Mundis, Gregory

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Anand, Neel

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Horn, Samantha R

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Segreto, Frank A

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Passfall, Lara

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Krol, Oscar

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Diebo, Bassel

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Burton, Doug

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Buckland, Aaron

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Gerling, Michael

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Soroceanu, Alex

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Eastlack, Robert

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Kojo Hamilton, D

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Hart, Robert

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Schwab, Frank

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Lafage, Virginie

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Shaffrey, Christopher

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Sciubba, Daniel

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Bess, Shay

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Ames, Christopher

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Klineberg, Eric

dc.contributor.author

International Spine Study Group

dc.date.accessioned

2023-06-15T18:00:16Z

dc.date.available

2023-06-15T18:00:16Z

dc.date.issued

2022-04

dc.date.updated

2023-06-15T18:00:15Z

dc.description.abstract

Background

More sophisticated surgical techniques for correcting adult spinal deformity (ASD) have increased operative times, adding to physiologic stress on patients and increased complication incidence. This study aims to determine factors associated with operative time using a statistical learning algorithm.

Methods

Retrospective review of a prospective multicenter database containing 837 patients undergoing long spinal fusions for ASD. Conditional inference decision trees identified factors associated with skin-to-skin operative time and cutoff points at which factors have a global effect. A conditional variable-importance table was constructed based on a nonreplacement sampling set of 2000 conditional inference trees. Means comparison for the top 15 variables at their respective significant cutoffs indicated effect sizes.

Results

Included: 544 surgical ASD patients (mean age: 58.0 years; fusion length 11.3 levels; operative time: 378 minutes). The strongest predictor for operative time was institution/surgeon. Center/surgeons, grouped by decision tree hierarchy, a and b were, on average, 2 hours faster than center/surgeons c-f, who were 43 minutes faster than centers g-j, all P < 0.001. The next most important predictors were, in order, approach (combined vs posterior increases time by 139 minutes, P < 0.001), levels fused (<4 vs 5-9 increased time by 68 minutes, P < 0.050; 5-9 vs < 10 increased time by 47 minutes, P < 0.001), age (age <50 years increases time by 57 minutes, P < 0.001), and patient frailty (score <1.54 increases time by 65 minutes, P < 0.001). Surgical techniques, such as three-column osteotomies (35 minutes), interbody device (45 minutes), and decompression (48 minutes), also increased operative time. Both minor and major complications correlated with <66 minutes of increased operative time. Increased operative time also correlated with increased hospital length of stay (LOS), increased estimated intraoperative blood loss (EBL), and inferior 2-year Oswestry Disability Index (ODI) scores.

Conclusions

Procedure location and specific surgeon are the most important factors determining operative time, accounting for operative time increases <2 hours. Surgical approach and number of levels fused were also associated with longer operative times, respectively. Extended operative time correlated with longer LOS, higher EBL, and inferior 2-y ODI outcomes.

Clinical relevance

We further identified the poor outcomes associated with extended operative time during surgical correction of ASD, and attributed the useful predictors of time spent in the operating room, including site, surgeon, surgical approach, and the number of levels fused.

Level of evidence: 3

dc.identifier

16/2/291

dc.identifier.issn

2211-4599

dc.identifier.issn

2211-4599

dc.identifier.uri

https://hdl.handle.net/10161/28026

dc.language

eng

dc.publisher

International Journal of Spine Surgery

dc.relation.ispartof

International journal of spine surgery

dc.relation.isversionof

10.14444/8174

dc.subject

International Spine Study Group

dc.title

Predictive Analytics for Determining Extended Operative Time in Corrective Adult Spinal Deformity Surgery.

dc.type

Journal article

duke.contributor.orcid

Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

291

pubs.end-page

299

pubs.issue

2

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

16

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