RT Journal Article
SR Electronic
T1 External Validation of the National Surgical Quality Improvement Program Calculator Utilizing a Single Institutional Experience for Adult Spinal Deformity Corrective Surgery
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8419
DO 10.14444/8419
A1 Naessig, Sara
A1 Pierce, Katherine
A1 Ahmad, Waleed
A1 Passfall, Lara
A1 Krol, Oscar
A1 Kummer, Nicholas A.
A1 Williamson, Tyler
A1 Imbo, Bailey
A1 Tretiakov, Peter
A1 Moattari, Kevin
A1 Joujon-Roche, Rachel
A1 Zhong, Jack
A1 Balouch, Eaman
A1 O’Connell, Brooke
A1 Maglaras, Constance
A1 Diebo, Bassel
A1 Lafage, Renaud
A1 Lafage, Virginie
A1 Vira, Shaleen
A1 Hale, Steven
A1 Gerling, Michael
A1 Protopsaltis, Themistocles
A1 Buckland, Aaron
A1 Passias, Peter G.
YR 2023
UL https://www.ijssurgery.com/content/early/2023/02/15/8419.abstract
AB Background Identify the external applicability of the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) risk calculator in the setting of adult spinal deformity (ASD) and subsets of patients based on deformity and frailty status.Methods ASD patients were isolated in our single-center database and analyzed for the shared predictive variables displayed in the NSQIP calculator. Patients were stratified by frailty (not frail <0.03, frail 0.3–0.5, severely frail >0.5), deformity [T1 pelvic angle (TPA) > 30, pelvic incidence minus lumbar lordosis (PI-LL) > 20], and reoperation status. Brier scores were calculated for each variable to validate the calculator’s predictability in a single center’s database (Quality). External validity of the calculator in our ASD patients was assessed via Hosmer-Lemeshow test, which identified whether the differences between observed and expected proportions are significant.Results A total of 1606 ASD patients were isolated from the Quality database (48.7 years, 63.8% women, 25.8 kg/m2); 33.4% received decompressions, and 100% received a fusion. For each subset of ASD patients, the calculator predicted lower outcome rates than what was identified in the Quality database. The calculator showed poor predictability for frail, deformed, and reoperation patients for the category “any complication” because they had Brier scores closer to 1. External validity of the calculator in each stratified patient group identified that the calculator was not valid, displaying P values >0.05.Conclusion The NSQIP calculator was not a valid calculator in our single institutional database. It is unable to comment on surgical complications such as return to operating room, surgical site infection, urinary tract infection, and cardiac complications that are typically associated with poor patient outcomes. Physicians should not base their surgical plan solely on the NSQIP calculator but should consider multiple preoperative risk assessment tools.Level of Evidence 3.