Predictive model for major complications 2 years after corrective spine surgery for adult spinal deformity

European spine journal

article

Mitsuru Yagi¹  Naobumi Hosogane³  Nobuyuki Fujita¹  Eijiro Okada¹  Osahiko Tsuji¹  Narihito Nagoshi¹  Takashi Asazuma²  Takashi Tsuji³  Masaya Nakamura¹  Morio Matsumoto¹  Kota Watanabe¹ 

[1] Department of Orthopedic Surgery, Keio University School of Medicine;Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center;Keio Spine Research Group;Department of Orthopedic Surgery, National Defense Medical College;Department of Orthopedic Surgery, Fujita Health University

关键词: Adult spinal deformity;    Complication;    Surgery;    Risk stratifcation;    Predictive model;   

DOI  :  10.1007/s00586-018-5816-5

来源: Springer

【 摘 要 】

ASD surgery improves a patient’s health-related quality of life, but it has a high complication rate. The aim of this study was to create a predictive model for complications after surgical treatment for adult spinal deformity (ASD), using spinal alignment, demographic data, and surgical invasiveness. This study included 195 surgically treated ASD patients who were > 50 years old and had 2-year follow-up from multicenter database. Variables which included age, gender, BMI, BMD, frailty, fusion level, UIV and LIV, primary or revision surgery, pedicle subtraction osteotomy, spinal alignment, Schwab-SRS type, surgical time, and blood loss were recorded and analyzed at least 2 years after surgery. Decision-making trees for 2-year postoperative complications were constructed and validated by a 7:3 data split for training and testing. External validation was performed for 25 ASD patients who had surgery at a different hospital. Complications developed in 48% of the training samples. Almost half of the complications developed in late post-op period, and implant-related complications were the most common complication at 2 years after surgery. Univariate analyses showed that BMD, frailty, PSO, LIV, PI-LL, and EBL were risk factors for complications. Multivariate analysis showed that low BMD, PI-LL > 30°, and frailty were independent risk factors for complications. In the testing samples, our predictive model was 92% accurate with an area under the receiver operating characteristic curve of 0.963 and 84% accurate in the external validation. A successful model was developed for predicting surgical complications. Our model could inform physicians about the risk of complications in ASD patients in the 2-year postoperative period. These slides can be retrieved under Electronic Supplementary Material.

【 授权许可】

Unknown