Predicting the occurrence of complications following corrective cervical deformity surgery: Analysis of a prospective multicenter database using predictive analytics

International Spine Study Group.

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We developed a predictive model to describe risk factors for complications in cervical deformity surgeries. Cervical deformity (CD) surgical patients are growing in number, but remain under-studied in the literature. CD was defined as at least one of the following: C2–C7 Cobb >10° CL >10° cSVA >4 cm, CBVA >25°. Patient demographics and clinical data were assessed as risk factors for medical/surgical complications using multivariate regression models. 123 patients underwent CD surgery (60.6 yrs, 60.8% F). The most common complications were neurologic (24.4%), dysphagia (13.0%), cardiopulmonary (11.4%), infection (9.7%). 51 (41.5%) of patients experienced a medical complication and 73 (59.3%) had a surgical complication. An overall complication was predicted with high accuracy (AUC = 0.79) by the following combinations of factors: higher baseline EQ5D pain and lower baseline EQ5D anxiety/depression scores, and higher cervical and global SVA. A medical complication can be predicted by male gender, baseline mJOA score, and cervical SVA (AUC = 0.770). A surgical complication can be predicted by higher estimated blood loss, lower anxiety scores, and larger global SVA (AUC = 0.739). 64.2% of patients undergoing cervical deformity correction sustained any complication. While the most reliable predictor of the occurrence of a complication involved a cluster of risk factors, a radiographic baseline sagittal parameter of cervical SVA was the strongest isolated predictor for complications across categories. Although these findings are specific to a cervical population with moderate to severe deformities, collectively they can be utilized for pre-operative risk assessment and patient education.

Original languageEnglish (US)
JournalJournal of Clinical Neuroscience
DOIs
StateAccepted/In press - Jan 1 2018

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Databases
Area Under Curve
Anxiety
Patient Education
Deglutition Disorders
Nervous System
Demography
Depression
Pain
Infection
Population

Keywords

  • Cervical deformity
  • Clinical outcomes
  • Health-related quality of life scores
  • Medical complications
  • Predictive model
  • Surgical complications
  • Surgical correction

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

@article{2d4c1b6337f34c23bccab522b2f6d264,
title = "Predicting the occurrence of complications following corrective cervical deformity surgery: Analysis of a prospective multicenter database using predictive analytics",
abstract = "We developed a predictive model to describe risk factors for complications in cervical deformity surgeries. Cervical deformity (CD) surgical patients are growing in number, but remain under-studied in the literature. CD was defined as at least one of the following: C2–C7 Cobb >10° CL >10° cSVA >4 cm, CBVA >25°. Patient demographics and clinical data were assessed as risk factors for medical/surgical complications using multivariate regression models. 123 patients underwent CD surgery (60.6 yrs, 60.8{\%} F). The most common complications were neurologic (24.4{\%}), dysphagia (13.0{\%}), cardiopulmonary (11.4{\%}), infection (9.7{\%}). 51 (41.5{\%}) of patients experienced a medical complication and 73 (59.3{\%}) had a surgical complication. An overall complication was predicted with high accuracy (AUC = 0.79) by the following combinations of factors: higher baseline EQ5D pain and lower baseline EQ5D anxiety/depression scores, and higher cervical and global SVA. A medical complication can be predicted by male gender, baseline mJOA score, and cervical SVA (AUC = 0.770). A surgical complication can be predicted by higher estimated blood loss, lower anxiety scores, and larger global SVA (AUC = 0.739). 64.2{\%} of patients undergoing cervical deformity correction sustained any complication. While the most reliable predictor of the occurrence of a complication involved a cluster of risk factors, a radiographic baseline sagittal parameter of cervical SVA was the strongest isolated predictor for complications across categories. Although these findings are specific to a cervical population with moderate to severe deformities, collectively they can be utilized for pre-operative risk assessment and patient education.",
keywords = "Cervical deformity, Clinical outcomes, Health-related quality of life scores, Medical complications, Predictive model, Surgical complications, Surgical correction",
author = "{International Spine Study Group.} and Passias, {Peter G.} and Cheongeun Oh and Horn, {Samantha R.} and Kim, {Han Jo} and Hamilton, {D. Kojo} and Sciubba, {Daniel M.} and Neuman, {Brian J.} and Buckland, {Aaron J.} and Poorman, {Gregory W.} and Segreto, {Frank A.} and Bortz, {Cole A.} and Brown, {Avery E.} and Protopsaltis, {Themistocles S.} and Klineberg, {Eric Otto} and Christopher Ames and Smith, {Justin S.} and Virginie Lafage",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jocn.2018.10.111",
language = "English (US)",
journal = "Journal of Clinical Neuroscience",
issn = "0967-5868",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Predicting the occurrence of complications following corrective cervical deformity surgery

T2 - Analysis of a prospective multicenter database using predictive analytics

AU - International Spine Study Group.

AU - Passias, Peter G.

AU - Oh, Cheongeun

AU - Horn, Samantha R.

AU - Kim, Han Jo

AU - Hamilton, D. Kojo

AU - Sciubba, Daniel M.

AU - Neuman, Brian J.

AU - Buckland, Aaron J.

AU - Poorman, Gregory W.

AU - Segreto, Frank A.

AU - Bortz, Cole A.

AU - Brown, Avery E.

AU - Protopsaltis, Themistocles S.

AU - Klineberg, Eric Otto

AU - Ames, Christopher

AU - Smith, Justin S.

AU - Lafage, Virginie

PY - 2018/1/1

Y1 - 2018/1/1

N2 - We developed a predictive model to describe risk factors for complications in cervical deformity surgeries. Cervical deformity (CD) surgical patients are growing in number, but remain under-studied in the literature. CD was defined as at least one of the following: C2–C7 Cobb >10° CL >10° cSVA >4 cm, CBVA >25°. Patient demographics and clinical data were assessed as risk factors for medical/surgical complications using multivariate regression models. 123 patients underwent CD surgery (60.6 yrs, 60.8% F). The most common complications were neurologic (24.4%), dysphagia (13.0%), cardiopulmonary (11.4%), infection (9.7%). 51 (41.5%) of patients experienced a medical complication and 73 (59.3%) had a surgical complication. An overall complication was predicted with high accuracy (AUC = 0.79) by the following combinations of factors: higher baseline EQ5D pain and lower baseline EQ5D anxiety/depression scores, and higher cervical and global SVA. A medical complication can be predicted by male gender, baseline mJOA score, and cervical SVA (AUC = 0.770). A surgical complication can be predicted by higher estimated blood loss, lower anxiety scores, and larger global SVA (AUC = 0.739). 64.2% of patients undergoing cervical deformity correction sustained any complication. While the most reliable predictor of the occurrence of a complication involved a cluster of risk factors, a radiographic baseline sagittal parameter of cervical SVA was the strongest isolated predictor for complications across categories. Although these findings are specific to a cervical population with moderate to severe deformities, collectively they can be utilized for pre-operative risk assessment and patient education.

AB - We developed a predictive model to describe risk factors for complications in cervical deformity surgeries. Cervical deformity (CD) surgical patients are growing in number, but remain under-studied in the literature. CD was defined as at least one of the following: C2–C7 Cobb >10° CL >10° cSVA >4 cm, CBVA >25°. Patient demographics and clinical data were assessed as risk factors for medical/surgical complications using multivariate regression models. 123 patients underwent CD surgery (60.6 yrs, 60.8% F). The most common complications were neurologic (24.4%), dysphagia (13.0%), cardiopulmonary (11.4%), infection (9.7%). 51 (41.5%) of patients experienced a medical complication and 73 (59.3%) had a surgical complication. An overall complication was predicted with high accuracy (AUC = 0.79) by the following combinations of factors: higher baseline EQ5D pain and lower baseline EQ5D anxiety/depression scores, and higher cervical and global SVA. A medical complication can be predicted by male gender, baseline mJOA score, and cervical SVA (AUC = 0.770). A surgical complication can be predicted by higher estimated blood loss, lower anxiety scores, and larger global SVA (AUC = 0.739). 64.2% of patients undergoing cervical deformity correction sustained any complication. While the most reliable predictor of the occurrence of a complication involved a cluster of risk factors, a radiographic baseline sagittal parameter of cervical SVA was the strongest isolated predictor for complications across categories. Although these findings are specific to a cervical population with moderate to severe deformities, collectively they can be utilized for pre-operative risk assessment and patient education.

KW - Cervical deformity

KW - Clinical outcomes

KW - Health-related quality of life scores

KW - Medical complications

KW - Predictive model

KW - Surgical complications

KW - Surgical correction

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U2 - 10.1016/j.jocn.2018.10.111

DO - 10.1016/j.jocn.2018.10.111

M3 - Article

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JO - Journal of Clinical Neuroscience

JF - Journal of Clinical Neuroscience

SN - 0967-5868

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