PT  - JOURNAL ARTICLE
AU  - Bortz, Cole A.
AU  - Pierce, Katherine E.
AU  - Krol, Oscar
AU  - Kummer, Nicholas
AU  - Passfall, Lara
AU  - Egers, Max
AU  - Oh, Cheongeun
AU  - Horn, Samantha R.
AU  - Segreto, Frank A.
AU  - Vasquez-Montes, Dennis
AU  - Frangella, Nicholas J.
AU  - Buza, John A.
AU  - Raman, Tina
AU  - Kuprys, Tomas
AU  - Lafage, Renaud
AU  - Jankowski, Pawel P.
AU  - Hassanzadeh, Hamid
AU  - Vira, Shaleen N.
AU  - Diebo, Bassel G.
AU  - Gerling, Michael C.
AU  - Passias, Peter G.
TI  - Predictors of Complication Severity Following Adult Spinal Deformity Surgery: Smoking Rate, Diabetes, and Osteotomy Increase Risk of Severe Adverse Events
AID  - 10.14444/8393
DP  - 2023 Feb 03
TA  - International Journal of Spine Surgery
PG  - 8393
4099  - https://www.ijssurgery.com/content/early/2023/02/03/8393.short
4100  - https://www.ijssurgery.com/content/early/2023/02/03/8393.full
AB  - Background Given the physical and economic burden of complications in spine surgery, reducing the prevalence of perioperative adverse events is a primary concern of both patients and health care professionals. This study aims to identify specific perioperative factors predictive of developing varying grades of postoperative complications in adult spinal deformity (ASD) patients, as assessed by the Clavien-Dindo complication classification (Cc) system.Methods Surgical ASD patients ≥18 years were identified in the American College of Surgeons’ National Surgical Quality Improvement Program from 2005 to 2015. Postoperative complications were stratified by Cc grade severity: minor (I, II, and III) and severe (IV and V). Stepwise regression models generated dataset-specific predictive models for Cc groups. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the model. Significance was set at P < 0.05.Results Included were 3936 patients (59 ± 16 years, 63% women, 29 ± 7 kg/m2) undergoing surgery for ASD (4.4 ± 4.7 levels, 71% posterior approach, 11% anterior, and 18% combined). Overall, 1% of cases were revisions, 39% of procedures involved decompression, 27% osteotomy, and 15% iliac fixation. Additionally, 66% of patients experienced at least 1 complication, 0% of which were Cc grade I, 51% II, 5% III, 43% IV, and 1% V. The final model predicting severe Cc (IV–V) complications yielded an AUC of 75.6% and included male sex, diabetes, increased operative time, central nervous system tumor, osteotomy, cigarette pack-years, anterior decompression, and anterior lumbar interbody fusion. Final models predicting specific Cc grades were created.Conclusions Specific predictors of adverse events following ASD-corrective surgery varied for complications of different severities. Multivariate modeling showed smoking rate, osteotomy, diabetes, anterior lumbar interbody fusion, and higher operative time, among other factors, as predictive of severe complications, as classified by the Clavien-Dindo Cc system. These factors can help in the identification of high-risk patients and, consequently, improve preoperative patient counseling.Clinical Relevance The findings of this study provide a foundation for identifying ASD patients at high risk of postoperative complications .Level of Evidence 4.