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New model predicts risk of complications after adult spinal deformity surgery

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US researchers have developed a model that can predict major complications following surgery for adult spinal deformity (ASD).

The study was launched because the operative management of patients with ASD has a high complication rate and it was not known whether baseline patient characteristics and surgical variables could predict early complications (intraoperative and perioperative within six weeks of the procedure).

It’s thought that an accurate preoperative predictive model could aid in patient counselling, shared decision making and improved surgical planning.

For the study, the research team gathered data on 557 patients in an ASD database. Of these patients, 148 had at least one major intraoperative or perioperative complication and 409 patients had no complications.

The investigators created a model that uses baseline radiographic, demographic and surgical factors to predict major intraoperative or perioperative complications following adult spinal deformity surgery.

The research identified 20 variables that were the top predictors, including age, leg pain, Oswestry Disability Index, number of decompression levels, number of interbody fusion levels, Physical Component Summary of the SF-36, Scoliosis Research Society (SRS)-Schwab coronal curve type, Charlson Comorbidity Index, SRS activity, T-1 pelvic angle, American Society of Anesthesiologists grade, presence of osteoporosis, pelvic tilt, sagittal vertical axis, primary versus revision surgery, SRS pain, SRS total, use of bone morphogenetic protein, use of iliac crest graft, and pelvic incidence-lumbar lordosis mismatch.

According to the study, published in the Journal of Neurosurgery: Spine, the overall model accuracy was found to be 87.6% correct, with a curve that demonstrated the model as having a “very good” fit.

“This model can provide the foundation toward improved education and point-of-care decision making for patients undergoing ASD surgery,” the researchers wrote.

https://www.healio.com/orthopedics/spine/news/online/%7Bea160404-71e8-4518-b5b2-ccc1257d5eed%7D/model-developed-to-predict-development-of-complications-in-adult-spinal-deformity-surgery

http://thejns.org/doi/abs/10.3171/2016.10.SPINE16197