American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator as a Predictor of Postoperative Outcomes After Adult Spinal Deformity Surgery: A Retrospective Cohort Analysis.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY Neurosurgery Pub Date : 2025-02-01 Epub Date: 2024-06-27 DOI:10.1227/neu.0000000000003066

Justin Im, Mohamed A R Soliman, Alexander O Aguirre, Esteban Quiceno, Evan Burns, Ali M A Khan, Cathleen C Kuo, Rehman A Baig, Asham Khan, Ryan M Hess, John Pollina, Jeffrey P Mullin

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Abstract

Background and objectives: In recent years, there has been an outpouring of scoring systems that were built to predict outcomes after various surgical procedures; however, research validating these studies in spinal surgery is quite limited. In this study, we evaluated the predictability of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP SRC) for various postoperative outcomes after spinal deformity surgery.

Methods: A retrospective chart review was conducted to identify patients who underwent spinal deformity surgery at our hospital between January 1, 2014, and December 31, 2022. Demographic and clinical data necessary to use the ACS NSQIP SRC and postoperative outcomes were collected for these patients. Predictability was analyzed using the area under the curve (AUC) of receiver operating characteristic curves and Brier scores.

Results: Among the 159 study patients, the mean age was 64.5 ± 9.5 years, mean body mass index was 31.9 ± 6.6, and 95 (59.7%) patients were women. The outcome most accurately predicted by the ACS NSQIP SRC was postoperative pneumonia (observed = 5.0% vs predicted = 3.2%, AUC = 0.75, Brier score = 0.05), but its predictability still fell below the acceptable threshold. Other outcomes that were underpredicted by the ACS NSQIP SRC were readmission within 30 days (observed = 13.8% vs predicted = 9.0%, AUC = 0.63, Brier score = 0.12), rate of discharge to nursing home or rehabilitation facilities (observed = 56.0% vs predicted = 46.6%, AUC = 0.59, Brier = 0.26), reoperation (observed 11.9% vs predicted 5.4%, AUC = 0.60, Brier = 0.11), surgical site infection (observed 9.4% vs predicted 3.5%, AUC = 0.61, Brier = 0.05), and any complication (observed 33.3% vs 19%, AUC = 0.65, Brier = 0.23). Predicted and observed length of stay were not significantly associated (β = 0.132, P = .47).

Conclusion: The ACS NSQIP SRC is a poor predictor of outcomes after spinal deformity surgery.

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美国外科学院国家手术质量改进计划手术风险计算器作为成人脊柱畸形手术后结果的预测指标：回顾性队列分析

背景和目的：近年来，为预测各种外科手术后的结果而建立的评分系统层出不穷；然而，在脊柱外科手术中验证这些研究的研究却相当有限。在本研究中，我们评估了美国外科医生学会国家外科质量改进计划外科风险计算器（ACS NSQIP SRC）对脊柱畸形手术后各种术后结果的预测能力：我们对病历进行了回顾性分析，以确定2014年1月1日至2022年12月31日期间在我院接受脊柱畸形手术的患者。收集了使用 ACS NSQIP SRC 所需的人口统计学和临床数据以及这些患者的术后结果。使用接收者操作特征曲线的曲线下面积（AUC）和布赖尔评分分析了可预测性：在 159 名研究患者中，平均年龄为（64.5±9.5）岁，平均体重指数为（31.9±6.6），95 名（59.7%）患者为女性。ACS NSQIP SRC 预测最准确的结果是术后肺炎（观察值 = 5.0% vs 预测值 = 3.2%，AUC = 0.75，Brier 评分 = 0.05），但其可预测性仍低于可接受的阈值。ACS NSQIP SRC 预测不足的其他结果包括：30 天内再入院率（观察值 = 13.8% vs 预测值 = 9.0%，AUC = 0.63，Brier 评分 = 0.12）、出院到疗养院或康复设施的比率（观察值 = 56.0% vs 预测值 = 46.6%，AUC = 0.59，Brier = 0.26）、再次手术（观察值 11.9% vs 预测值 5.4%，AUC = 0.60，Brier = 0.11）、手术部位感染（观察值 9.4% vs 预测值 3.5%，AUC = 0.61，Brier = 0.05）和任何并发症（观察值 33.3% vs 预测值 19%，AUC = 0.65，Brier = 0.23）。预测住院时间与观察住院时间无明显相关性（β = 0.132，P = .47）：结论：ACS NSQIP SRC是脊柱畸形手术后预后的不良预测指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.