Faculty Bibliography

BACKGROUND CONTEXT: While past research has shown racial disparities exist in the outcomes and utilization of spine surgery, those studies were often performed on nondisease-specific national databases, which may capture different patient populations and complication rates compared to prospective multicenter databases. PURPOSE: Purpose: 1) Assess racial disparities for enrollment in two prospective multicenter databases (ASD-

BACKGROUND CONTEXT: While reimbursement is centered on 90-day outcomes, some patients persevere through these short-term, transient complications and manage to still achieve optimal, long-term outcomes. PURPOSE: Assess whether achieving optimal alignment suffering similar perioperative complications compared to suboptimally-aligned peers are inhibited from reaching long-term clinical success and better cost-utility. STUDY DESIGN/SETTING: Retrospective cohort study of a prospective adult spinal deformity (ASD) database. PATIENT SAMPLE: A total of 1,541 patients. OUTCOME MEASURES: Cost-per-QALY, radiographic realignment, clinical outcomes.
METHOD(S): Operative ASD pts with 2Y data were included. Optimal radiographic outcome was defined by SRS-Schwab low deformity in PI-LL, matched in T1PA and being aligned in PI-based PT at 6 weeks. After stratifying pts based on meeting optimal outcome, multivariate analysis controlling for baseline demographics was used to determine significance for complications and hospital-acquired conditions (HACs; DVT/PE, UTI, deep/superficial infection). Calculated Cost per QALY for each time point by 2Y.
RESULT(S): There were 917 ASD pts included. Regarding approach, 69% posterior approach, 31% combined. Groups: 131 were "optimal" (O) and 786 were "not optimal" (NO). Means comparison tests revealed significant differences in age, BMI, but not gender or frailty. The NO group had fewer osteotomies and a lower Invasiveness Index. Analysis of perioperative complications showed that the O group suffered equivocal perioperative complications (58.0% vs 52.2% in the NO group; p=.173) and rates of HACs (9.0% vs. 8.9%, p=.810). Analysis of long-term complications showed that patients in the NO group suffered more major neurological (p=.015) and major mechanical complications (p=.025), and more reoperations (28.7% vs 19.9%; p=.037). When controlling for baseline deformity, age, BMI and frailty, Optimal Outcome patients more often met Best Clinical Outcome (21.5% vs. 11.7%, p=.002). Cost-utility adjusted analysis with determined no difference in the two groups by 6 weeks and 6 months. However, the O group generated significantly better cost-utility by one year, which maintained lower Costs per QALY (p=.005) at two years in favor of the O group.
CONCLUSION(S): Despite incurring equivocal perioperative complications, patients who met our optimal outcome criteria experienced significantly less mechanical complications and reoperations by 2 years, leading to a better long-term cost-utility overall. Accordingly, a higher, transient perioperative complication profile should not preclude surgical correction and future policy efforts should place more consideration on the long-term for outcome measures in adult spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The comparison of various frailty indices and their ability to predict complications after ASD surgery has not been investigated. PURPOSE: Assess whether certain frailty indices have predictability of complication rates following ASD surgery. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 689 ASD patients. OUTCOME MEASURES: Complication rates, clinical outcomes, cost-utility.
METHOD(S): Operative ASD patients with baseline (BL) and 2-year (2Y) data were included. Four frailty indices were used for comparison: Passias et al modified ASD frailty index (mFI), Miller et al ASD frailty index (FI-ASD), the ACS-NSQIP 5-Factor frailty index (ACS-FI5), and the FRAIL Scale (PMID:29792992). Patients were stratified into not frail (NF), frail (F) and severely frail (SF). Associations of the indices with EBL, op time, complications, hospital-acquired conditions (HAC: UTI, DVT/PE, SSI), reoperations, SICU stay, and LOS were compared using one-way ANOVA, logistic and linear regression analyses.
RESULT(S): There were 421 ASD patients included (Age: 60.4, BMI: 28.0, CCI: 1.9). Total cohort complication rates: 71% any comp, 27% major (68% were surgical, 32% medical), 35% minor, 25% intraoperative, 18% mechanical, 22% underwent reoperation. Upon presentation, severely frail patients were much more likely to present with a severe ODI (OR: 16, [7.2-29.8]). All four indices significantly correlated with intraop details and comps. During hospital stay, all four indices correlated to SICU time and total LOS. Only FRAIL Scale correlated with SICU admission rate (OR: 1.2, [1.03-8.8]), while no index was predictive of comps prior to discharge (all p>.05). ASD-FI had the strongest correlation with periop comps, including HACs (OR: 1.2, [1.1-6.3]), any (OR: 1.2, [1.02-7.3]) and major comps (OR: 1.5, [1.1-4.7]). When assessing 2Y comps, logistic regression analysis demonstrated correlation between ASD-FI, mFI, and FRAIL Scale indices and any comps, major comps and reoperation. However, mFI was the only correlate for all 2Y comps (any, major, minor, mech, reop), along with highest OR for predicting mechanical comps (OR: 1.6, [1.3-1.9]). Clinically, ASD-FI SF group had the greatest improvement (ODI,SRS-Total), while mFI SF had lowest rates of improvement. Given their higher complication rates, this translated to higher cost per QALY by 2 years for SF pts when stratified by mFI (p<.001).
CONCLUSION(S): Frailty imposes a significant burden on adult spinal deformity patients from the moment of presentation through cost-utility at two years. Assessing frailty by different measures demonstrated meaningful differences in complications and outcomes. These findings highlight the impact of frailty stratification during surgical planning to effectively assess the risk of patients undergoing corrective surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Bone Morphogenetic Protein-2 (BMP-2) has not shown superior benefit in terms of overall cost-effectiveness after implementation during adult spinal deformity (ASD) surgery. However, it remains to be shown whether certain discrete populations do obtain cost-utility from use of BMP-2. PURPOSE: Generate a score to determine usage of BMP-2 and correlate with rates of pseudarthrosis. STUDY DESIGN/SETTING: Retrospective cohort study of a single-center ASD database. PATIENT SAMPLE: A total of 689 ASD patients. OUTCOME MEASURES: Cost utility, pseudarthrosis.
METHOD(S): ASD patients with BL and 2-year(2Y) data included. BMP-2 kit size and cost: small - 4.2 mg ($21,800), medium - 8.4 mg ($23,667), large - 12 mg ($25,617). Published methods converted ODI to SF-6D. QALYs utilized a 3% discount rate for residual decline. Cost was calculated using the PearlDiver database and assessed for Complications and Comorbidities and Major Complications and Comorbidities according to CMS.gov definitions. Binary logistic regression analyses determined significant predictors for development of pseudarthrosis. Established weights were generated for predictive variables via back-step logistic regression for a risk score to predict development of pseudarthrosis. Risk score was then validated via Receiver Operating Characteristic (ROC) curve method analysis. Categories via conditional inference tree (CIT) analysis-derived thresholds were tested for cost-utility of BMP-2 usage. Marginalized means for utility gained and Cost per QALY were calculated within each risk score category, controlling for age, history of prior fusion, and baseline deformity and disability.
RESULT(S): Included: 387 ASD patients. Of 387, 64% received BMP-2 (1% small, 4% medium, 59% large). There were 17 (4.4%) of patients that developed pseudarthrosis by two years, 9 (2.3%) of which underwent reoperation. BMP-2 use, regardless of kit size, did not significantly lower pseudarthrosis rates overall (OR: 0.4, [0.2-1.04]). A predictive risk score for development of pseudarthrosis was formed by the following preoperative variables: age, frailty, history of diabetes, osteoporosis, depression, ASA grade, and baseline L4-S1 and T1PA. Via ROC method, this predictive risk score generated an AUC of 0.87. Following CIT machine learning, thresholds for the BMP Risk Score were derived: >5 No Risk (NoR), 3-5 Low Risk (LowR), 2-3 Moderate Risk (ModR), and <2 High Risk (HighR). The rates of pseudarthrosis for each category were: NoR - 0%; LowR - 1.6%; ModR - 9.3%; HighR - 24.3%. When assessing BMP-2 use and its cost-utility within each group, patients receiving BMP-2 had similar QALYs to those that did not receive BMP-2 (0.163 vs 0.171, p=.65). BMP-2 usage had significantly worse cost-utility in both NoR and LowR cohorts (both p<.05). In ModR patients, BMP-2 usage had equivocal cost-utility ($680,532.35 vs $580,380.21, p=.14). In the HighR cohort, the cost-utility difference narrowed even further (BMP-2 use: $743,155.21 vs $719,628.79, p=.82).
CONCLUSION(S): Our study shows BMP-2 has equivocal cost-utility within those at moderate and high risk for developing pseudarthrosis within two years following spinal deformity correction. The generated predictive score can better aid spine surgeons assess risk and enhance justification for the use of BMP-2 during surgical intervention for adult spinal deformity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The durability of adult spinal deformity (ASD) surgery is key for cost-effective treatment. Malalignment is one of the main reasons for revision surgery. PURPOSE: To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery. STUDY DESIGN/SETTING: Retrospective cohort study of a prospective database. PATIENT SAMPLE: This study included 321 ASD patients with minimum 3 -year follow-up. OUTCOME MEASURES: L1-S1, L4-S1 and L1-L4 lumbar lordosis.
METHOD(S): A total of 321 patients who underwent fusion of the lumbar spine (=5 levels, LIV S1/ilium) with a revision-free follow-up =3 years were identified. Patients were stratified by the change in PI-LL from 6 weeks to 3 years postop as Maintained vs Loss > 5degree. Those with a loss due to instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Changes in regional and focal lordosis over time were investigated with repeated measures ANOVA and factor comparison.
RESULT(S): Mean age 64 yrs, BMI 28 kg/m², 80% female. The baseline alignment (PI-LL=21+/-19degree, T1PA=26+/-12degree) was corrected to PI-LL=3+/-13degree, and T1PA=18+/-10degree at 3 yrs (mean 3Y follow-up: 45+/-11m, with 44+/-11 mo between early and late follow-up). Eighty-two patients (25.5%) lost >5degree of PI-LL correction (mean loss 10+/-5degree). After exclusion of patients with instrumentation failure, 52 patients (Loss) with a mean loss of correction of 8.6+/-2.9 were compared to 222 controls with maintained LL correction. Demographics were similar between groups (age: 63 vs 61 p=0.15; Sex: 78.4% F vs 88.5% p=0.10). There were no significant differences in use of osteotomy, 3CO, and IBF between Loss and Maintained LL (all p >0.1). There was no significant difference in number of levels fused (11 vs 12 p=0.39), rod material (CoCr 59.4% vs 58.8% p=0.34), and BMP use (88.7% vs 84.6% p=0.41) but Loss had less supplemental rod use (5.8% vs 23.4% p=0.004). Comparison between Maintained and Loss revealed a similar PI-LL mismatch at pre-op (16.7+/-18.7 vs 20.9+/-18.3 p=0.14) and final postop (1.8+/-12.5 vs 5.1+/-14.5 p=0.11) but a significantly smaller PI-LL for Loss at early postop (0.6+/-12.8 vs -3.5+/-13.7 p=0.41). Distally, Maintained had a significant improvement in L4-S1 lordosis from preop to early postop (p=0.013), with no significant difference from early to final follow-up. In contrast, patients in the Loss group had no difference in L4-S1 from preop to early postop (p=0.14), but showed a significant loss of correction at 3 years (p <0.001). Proximally, significant increase between pre and early postop in L1-L4 (all p <0.001), with Loss and Maintained reaching similar early postop value (p=0.34). However, from early postop to final follow up, Loss showed a significant decrease in proximal lordosis (p <0.001) while Maintained did not (p=0.08), corresponding with a smaller absolute L1-L4 in the Loss cohort at 3 yrs (p=0.002). Screw orientation showed a significant decrease from early to late follow-up between the L1 and S1 screws for Loss (1.3+/-4.1 p=0.031), without any changes across the L4-S1 segment (-0.1+/-2.9 p=0.97).
CONCLUSION(S): Approximately a quarter of patients lose an average of 10degree of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (ie, tulip/shank angle shifts and/or rod bending), but lost distally through bone "settling" through the instrumentation itself. The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Previous reports indicate postoperative complications have minimal impact on long-term outcomes after ASD surgery. Little data has evaluated the impact of complications on specific heath domains during postoperative period. PURPOSE: To evaluate the impact of specific complications on patient reported health domains compared to patients with no complications. STUDY DESIGN/SETTING: Prospective, multicenter, propensity score matched analysis. PATIENT SAMPLE: ASD patients enrolled into a prospective multi-center study. OUTCOME MEASURES: Oswestry Disability Index, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), postoperative complications.
METHOD(S): Surgically treated ASD patients enrolled into a multicenter study were assessed for postoperative complications requiring surgery including wound (WOUND), pseudoarthrosis (PSEUDO), neurologic (NEURO) and malalignment (MAL) and matched to patients with no complications (NOCOMP) using inverse probability weighting for demographic, radiographic and surgical variables. Health domains for SRS-22r, and SF-36 were evaluated at regular time intervals, domain scores normalized to the date of revision surgery, and compared to patients with no complications at minimum 2-year follow-up.
RESULT(S): A total of 566 of 1130 were analyzed, average 3.6 yrs (range: 1.9 to 9). WOUND (n=12) compared to NOCOMP (n=390) had worse SF-36 physical function(21.7 vs 27.4), social function(19.6 vs 28.9), general health (-7.3 vs 8.9) and vitality (-0.9 vs 26.6,p < 0.05). PSEUDO (n=64) was worse than NOCOMP for SRS-22r function, 1.4 vs 2.1, and SF-36 social function, (17.1 vs 28.9) (p < 0.05). NEURO (n=28) was worse than NOCOMP for SRS-22r (0.9 vs 2.1), SF-36 bodily pain (14.7 vs 35.7) and social function (13.4 vs 28.9) (p < 0.05). MAL (n=72) was worse than NOCOMP for SRS-22r pain, (2.7 vs 3.4), function (1.2 vs 2.1), self-image (3.0 vs 3.9), SF-36 bodily pain (27.6 vs 35.7), physical function (18.7 vs 27.4), and social function (11.6 vs 28.9) (p < 0.05).
CONCLUSION(S): Counter to previous reports, specific postoperative complications requiring surgery uniquely impact specific health domains, resulting in worse patient reported quality of life compared to ASD patients with no complications. Social function was negatively impacted for all complications, while wound complications negatively impacted patient perceived general health and vitality and patients with malalignment requiring surgery reported worse self-image. These data highlight new findings that postoperative complications have a negative impact on specific aspects of ASD quality of life that can undermine the potential benefits of ASD surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Tranexamic acid (TXA) is commonly used to lower blood loss in ASD surgery. Despite widespread use of TXA in ASD surgery, there is a lack of consensus regarding the optimal dosing intraoperatively. PURPOSE: This study aims to assess differences in blood loss and complications between high-dose, medium-dose, and low-dose TXA regimens. Complex ASD patients who receive high-dose TXA will have decreased blood loss compared to those who receive low-dose TXA. STUDY DESIGN/SETTING: Retrospective Review. PATIENT SAMPLE: A total of 265 ASD patients in a multi-center prospective study were retrospectively analyzed. OUTCOME MEASURES: Blood loss (ml), Major Blood Loss (>90th percentile ml), units transfused intraoperatively, units transfused perioperatively.
METHOD(S): Patients were separated into three cohorts by TXA regimen: 1) low-dose patients had =20mg/kg loading dose with =2mg/kg/hr maintenance dose 2) medium-dose patients had 20-50 mg/kg loading dose with 2-5 mg/kg/hr maintenance dose. 3) high-dose patients had =50mg/kg loading dose with =5mg/kg/hr maintenance dose. Major or minor blood loss was defined as above or below the 90th percentile of our cohort respectively. Multivariable analysis controlled for levels fused, BMI, platelets, Hgb, OR time, 3CO, and radiographic alignment.
RESULT(S): Fifty-four (20%) patients received low-dose regimen, 133 (50%) received medium-dose and 80 (30%) received high dose. Mean blood loss was 1,551+/-1,295 ml, intraoperative units RBCs 1.52+/-2, and perioperative units RBCs 2.3+/-2.3. Mean major blood loss was 4,566+/-1,516ml and minor blood loss 1,236+/-755ml. Compared to the low-dose group, patients in the high-dose group had 77.8% decreased odds of major blood loss (OR 0.222; P=0.007), decreased blood loss (Coef. -540.92ml; P=0.019), units transfused intraoperatively (Coef. -.739 units; P < 0.001), and units transfused perioperatively (Coef. -0.328 units; P=0.025). Compared to medium-dose group, the high-dose group had less units transfused intraoperatively (Coef. -.59 units; P < 0.001) and perioperatively (Coef. -.42 units; P < 0.001) with no difference in blood loss. There was no difference between the medium and low dose groups in blood loss or units transfused. There was no association between high-dose TXA regimen and increased rates of DVT, PE, or any medical complication before six weeks. No patients had a seizure.
CONCLUSION(S): In this multicenter prospectively collected database, ASD patients receiving high-dose intraoperative TXA have decreased odds of major blood loss, less RBC transfusions intraoperatively and 540ml less blood loss compared to low dose TXA, without additional risk of seizure or thromboembolic complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Prophylaxis usage has been established in literature as an important component of minimizing the risk of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) development. However, literature is scarce on the effects of prophylaxis in patients who have achieved adequate postoperative alignment and those who maintained poor alignment postoperatively. PURPOSE: To investigate how PJK prophylaxis impacts rates of PJK and PJF with and without ideal alignment and the associated cost/cost-effectiveness. STUDY DESIGN/SETTING: Retrospective cohort study of a prospective adult thoracolumbar deformity database. PATIENT SAMPLE: This study included 1,541 patients. OUTCOME MEASURES: Radiographic alignment, patient-reported outcome measures (ODI), cost per QALY.
METHOD(S): Operative adult spinal deformity patients (scoliosis >20degree, SVA>5cm, PT>25degree, or TK>60degree) with an UIV at L1 or below and available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. "Matched" and "unmatched" alignment refers to the age-adjusted alignment criteria. PJK prophylaxis was defined by usage of cement, hooks or tethers. PJF was defined as PJK with reoperation. Costs were calculated using the PearlDiver database, accounting for additional costs of prophylaxis when applicable, through estimates from Medicare pay scales for services within a 30-day window, including estimates regarding costs of postoperative complications, outpatient healthcare encounters, revisions and medical related readmissions. QALY was calculated using SF6D.
RESULT(S): A total of 738 ASD patients or below met inclusion criteria (59.9yrs+/-14.0, 79%F, BMI: 27.7 kg/m2 +/-6.0, CCI: 1.8 +/-1.7). Surgically, patients had a mean level fused of 11.1+/-4.4, LOS of 7.9 days+/-4.4, EBL of 1577 mL, operative time of 377 min, with 63% undergoing an osteotomy. Forty percent of patients had PJK prophylaxis. Controlling for age, CCI, BL osteoporosis, levels fused, usage of 3CO, UIV, BL SVA and BL PI-LL, patients who were matched postoperatively in PT, SVA, or PI-LL had lowered PJF rates (OR:.5, 95% CI:.28-.86, p=.01) with prophylaxis. Among those unmatched in either SVA, PILL, or PT by 6W, prophylaxis significantly reduced the rates of PJK and PJF as well (p <0.05). ANCOVA controlling for age, CCI, BL osteoporosis, levels fused, usage of 3CO, UIV, BL SVA and BL PI-LL shows patients with ideal age-adjusted alignment and prophylaxis resulted in a lower cost per QALY by 2Y ($399,948 vs $514,228, p <.001). Similarly, in unmatched patients, prophylaxis resulted in a substantially lower cost per QALY by 2Y ($466,409 vs 672, 024, p <.001), primarily due to decreased costs of reoperation and greater improvements in QALY among prophylaxis cohorts.
CONCLUSION(S): Despite additional surgical cost, optimization of radiographic realignment in conjunction with utilization of proximal junctional failure prophylactic techniques achieves ideal cost utility, predominately due to the minimization of mechanical failure related reoperations. Even among those not achieving optimal alignment, junctional prophylactic measures improved cost utility, emphasizing its critical role of minimization of junctional failures to achieve cost efficiency in adult spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Several studies have suggested that Hounsfield units (HU) in the spine are associated with increased complications for adult spinal deformity (ASD) patients. PURPOSE: The aim of this study is to assess whether there exists a threshold for HU that is associated with increased blood loss following ASD surgery. We hypothesize that HU below thresholds on spinal CT are predictive of increased blood loss during surgery and implant complications within 90 days after surgery for ASD. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: ASD patients who had HU measured in the spine were identified from a multicenter database. OUTCOME MEASURES: High Intraoperative blood loss and implant complications within 90 days of surgery.
METHOD(S): HU at L1, upper instrumented vertebrae (UIV) and total averages were assessed. Threshold linear regression with Bayesian information criteria was utilized to identify optimal cut-offs for predicting high blood loss (>2100mL, top 25% by volume) or any implant complications within 90 days. Implant complications included loosening, breakage and dislocation of rods or screws. Multivariable logistic regression was utilized controlling for age, gender, comorbidity, osteotomy and levels fused.
RESULT(S): Of 527 patients included, the mean age was 61+/-14. Mean L1 HU was 154.59+/-87, UIV HU was 175.1+/-304, and total average HU was 165+/-168. There were 59 patients with high blood loss (mean 5,026+/-233ml) and 467 with low blood loss (1,331+/-39.5ml). Threshold regression analysis identified that a cut-off of =140.33 was optimal for predicting high blood loss and =99.75 total average HU was optimal for predicting implant complications within 90 days of surgery. On multivariable analysis, L1 HU less than 140 was associated with 1.57x higher odds of high blood loss (P=0.032). Total average HU less than 100 was associated with a 3.6x higher odds of having an implant related failure within 90 days of surgery (P=0.035).
CONCLUSION(S): In this prospective multi-center study, Those with L1 HU=140 had a 1.52x higher odds of high blood loss. Patients with an average HUof =100 have 3.6x higher odds of implant related complication within 90 days of surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The ACS-NSQIP and SpineSage are both easy to use and readily available online perioperative risk calculators The ACS-NSQIP calculator predicts perioperative complications after surgery, but lacks more spine-specific predictors. The SpineSage platform was developed as a tool built for predicting complications in spine surgery. While a limited number of studies have shown it be predictive of both overall and major medical complications in spine surgery, large external validation studies are limited and none have directly compared NSQIP against SpineSage in the same cohort of spine surgery patients. PURPOSE: Assess the ACS-NSQIP Risk Calculator and SpineSage informatics platform for prediction of perioperative complications in spine surgery STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 440 patients undergoing thoracolumbar spine with or without fusion. OUTCOME MEASURES: Any complication, serious complication, pneumonia, cardiac, dural tear, SSI, UTI, VTE, reoperation, death and LOS METHODS: Each patient was entered into the ACS-NSQIP and SpineSage calculators and predicted risk for specific complications were directly compared to actual risks. Paired t-tests compared the differences between calculators and their predictability of complications. Patients were ranked based on risk predicted for each complication and the highest tertile for each was isolated. Multivariate regression controlling for age and gender was used to determine if the highest tertile for each risk calculator had predictability in complications following spine surgery.
RESULT(S): Mean LOS 4.2+3 days, EBL 444+300 mL, operative time 256+240 min, and levels instrumented 2.1+2.3. When assessing the four complications predicted by SpineSage there were significant differences in three of the four variables, as SpineSage underpredicted the risk of all and serious-complications (p.5). Both calculator tertiles were trending towards significance for major medical complications (SpineSage: OR: 2.0, [0.94-4.23], p=.073; ACS-NSQIP: OR: 1.8,[0.96-3.48],p=.067). When examining any medical risk, only ACS NSQIP had significant predictability for any medical complication (OR: 2.1, [1.3-3.3]; p=.003).
CONCLUSION(S): Similar to previous studies, the ACS-NSQIP score underpredicted most complications, with the exception of LOS and death. In contrast to previous studies, our data suggest SpineSage was not predictive of actual rates of complications. As both calculators are highly accessible and provide at least some objective perioperative risk data points, we recommend them as a guiding tool but not as an absolute endpoint for clinical decision making as they may be inaccurate and insensitive. Further, higher powered studies elucidating the findings in this study should be conducted. Additionally, the assessment of these calculators for a specific subset of patients, such as deformity, degenerative or pediatrics, can further help guide clinicians regarding the utility of these calculators for their particular patient populations. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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