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Surgeon-specific risk stratification model for early complications after complex adult spinal deformity surgery

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Abstract

Study design

Retrospective outcome analysis of a prospectively collected single-surgeon cases

Objectives

Identify risk factors for complications in adult surgical spine deformity patients, develop a surgeon-specific risk stratification model, and predict the likelihood of 6-week postoperative complications based on prospectively collected preoperative measures.

Summary of background data

Adult spinal deformity surgery is challenging technically as well as economically. Although many risk factors are well known for spine surgery, complications after complex spine deformity surgery remain a significant problem worldwide.

Methods

We reviewed 124 consecutive adult patients who have undergone instrumented spinal fusion with nine or more levels over a 21-month period in a single institution. We extracted data from patient medical records. Complications within the 6 weeks after surgery were identified. Univariate and logistic regression analyses (LRAs) were implemented. We generated a formula based on the LRA predictive algorithm—a numeric probabilistic likelihood statistic representing an individual patient’s risk of developing a complication.

Results

A total of 34 (27%) patients had complications that were categorized into either 21 (17%) medical or 17 (13.7%) surgical complications, including 3 (2.4%) proximal junctional kyphosis, 8 (6.4%) neurologic deficit, and 9 (6.5%) any wound issue. The predictive model was significant and calibrated using area under the receiver operating characteristics curve analysis. The model correctly classified 83.1% cases. Patients with a three-column osteotomy or history of deep vein thrombosis have 6 and 19 times higher overall complications, respectively, compared with patients without. Patients with a three-column osteotomy or body mass index > 30, respectively, are 24 and 11 times more likely to develop a wound complication. Patients with a three-column osteotomy have 10 times higher rates of surgical complication.

Conclusions

Complex spine deformity is often associated with complications. No single variable effectively predicts postoperative complications for such a complicated situation. However, when all risk factors are considered, patients with three-column osteotomy have a significantly higher chance to develop early complications.

Level of Evidence

Level IV.

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Funding

No financial support was received for this research project.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, 22904, USA

    Xudong J. Li & Li Jin

  2. Department of Orthopedic Surgery, The Spine Hospital, Columbia University Medical Center, 650 West 168 Street, New York, NY, 10032, USA

    Xudong J. Li, Lawrence G. Lenke, Alexander Tuchman, Lee A. Tan, Ronald A. Lehman & Meghan Cerpa

  3. The Spine Hospital, New York Presbyterian/Allen, 5141 Broadway, New York, NY, 10034, USA

    Lawrence G. Lenke

Authors
  1. Xudong J. Li
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  2. Lawrence G. Lenke
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  3. Li Jin
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  4. Alexander Tuchman
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  5. Lee A. Tan
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  6. Ronald A. Lehman
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  7. Meghan Cerpa
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Corresponding author

Correspondence to Lawrence G. Lenke.

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Conflict of interest

XJL (none), LGL (personal fees from Medtronic, K2M, Fox Rothschild, LLC, and Quality Medical Publishing; grants and personal fees from DePuy-Synthes Spine; nonfinancial support from Broadwater, Seattle Science Foundation, Stryker Spine, and The Spinal Research Foundation; grants and nonfinancial support from Scoliosis Research Society and AOSpine; grants from EOS and Setting Scoliosis Straight Foundation; other from Evans Family Donation and Fox Family Foundation, outside the submitted work), LJ (none), AT (none), LAT (none), RAL (other from Medtronic, Stryker, and DePuy Synthes Spine, outside the submitted work), MC (none).

IRB approval

The study was approved by the Institutional Review Board.

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Li, X.J., Lenke, L.G., Jin, L. et al. Surgeon-specific risk stratification model for early complications after complex adult spinal deformity surgery. Spine Deform 8, 97–104 (2020). https://doi.org/10.1007/s43390-020-00047-y

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  • DOI: https://doi.org/10.1007/s43390-020-00047-y

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