Development of a Risk Prediction Model With Improved Clinical Utility in Elective Cervical and Lumbar Spine Surgery

Abstract

Study Design. Retrospective cohort. Objective. We present a universal model of risk prediction for patients undergoing elective cervical and lumbar spine surgery. Summary of Background Data. Previous studies illustrate predictive risk models as possible tools to identify individuals at increased risk for postoperative complications and high resource utilization following spine surgery. Many are specific to one condition or procedure, cumbersome to calculate, or include subjective variables limiting applicability and utility. Methods. A retrospective cohort of 177,928 spine surgeries (lumbar (L) Ln = 129,800; cervical (C) Cn = 48,128) was constructed from the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Cases were identified by Current Procedural Terminology (CPT) codes for cervical fusion, lumbar fusion, and lumbar decompression laminectomy. Significant preoperative risk factors for postoperative complications were identified and included in logistic regression. Sum of odds ratios from each factor was used to develop the Universal Spine Surgery (USS) score. Model performance was assessed using receiver-operating characteristic (ROC) curves and tested on 20% of the total sample. Results. Eighteen risk factors were identified, including sixteen found to be significant outcomes predictors. At least one complication was present among 11.1% of patients, the most common of which included bleeding requiring transfusion (4.86%), surgical site infection (1.54%), and urinary tract infection (1.08%). Complication rate increased as a function of the model score and ROC area under the curve analyses demonstrated fair predictive accuracy (lumbar = 0.741; cervical = 0.776). There were no significant deviations between score development and testing datasets. Conclusion. We present the Universal Spine Surgery score as a robust, easily administered, and cross-validated instrument to quickly identify spine surgery candidates at increased risk for postoperative complications and high resource utilization without need for algorithmic software. This may serve as a useful adjunct in preoperative patient counseling and perioperative resource allocation. Level of Evidence: 3

A predictive model of preoperative risk factors for venous thromboembolism after fusion for degenerative conditions of the thoracolumbar spine

“…To benchmark the model's performance, its discriminatory ability was compared with the ACS-NSQIP morbidity calculator, which has been demonstrated to be a valid instrument for assessing risk of postoperative complications after spine surgery. 14 All statistical analysis was performed within SPSS version 26 (IBM, Armonk, NY). Univariate tests performed for dichotomous variables included chi-square and Fisher's exact test when assumptions for chisquare analysis were not met.…”

Is routine blood typing and screening necessary for degenerative cervical spine surgery patients in specialty surgical hospitals?

“…In 2017 and 2020, from a retrospective cohort of 11,588 (Data from 2010 to 2013) and 48,128 (Data from 2012 to 2016) cervical spine surgeries, the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) reported a transfusion rate of 1.47 and 0.2%, respectively. 19,20 Maning et al, in a retrospective analysis of 332 patients who underwent an ACDF for degenerative cervical spine, found none of the patients required intraoperative or postoperative blood product transfusion. 21 For that reason, based on our results and the current literature, we think that the need of transfusion in patients with cervical spine surgeries is low, so all patients should not need a pretransfusion testing.…”

“…The rate of transfusion in our study is in concurrence with several prior studies that evaluated the incidence of transfusion and risk of transfusion in cervical spine surgery. In 2017 and 2020, from a retrospective cohort of 11,588 (Data from 2010 to 2013) and 48,128 (Data from 2012 to 2016) cervical spine surgeries, the American College of Surgeons National Surgical Quality Improvement Project (ACS‐NSQIP) reported a transfusion rate of 1.47 and 0.2%, respectively 19,20 . Maning et al, in a retrospective analysis of 332 patients who underwent an ACDF for degenerative cervical spine, found none of the patients required intraoperative or postoperative blood product transfusion 21 .…”

Epidemiological Relevance of Elevated Preoperative Patient Health Questionnaire-9 Scores on Clinical Improvement Following Lumbar Decompression

“…Risk factors associated with worse outcomes and postoperative complications following lumbar surgery include postoperative blood transfusion, 5 cancer, ethnicity, open wounds, ascites, renal failure, frailty, 6 body mass index (BMI), and cardiovascular diseases, which are among the most commonly studied. 7 Many of the aforementioned medical risk factors have been studied and analyzed on their own and in the context of risk prediction modeling.…”

“…6,17 Other difficulties encountered with predictive model use are related to the requirements for proprietary software, limited-access calculators, and significant institutional resources. 7 Risk models typically focus on perioperative factors, variables that are diseasespecific, and medical characteristics. Even in light of the increased discussion regarding the influence of psychiatric symptoms on spine surgery outcomes, this discussion is very limited within risk factor modeling.…”