title: A predictive model of complications after spine surgery: the National Surgical Quality Improvement Program (NSQIP) 2005-2010.
abstract: BACKGROUND
  There is increasing scrutiny by several regulatory bodies regarding the complications of spine surgery. Precise delineation of the risks contributing to those complications remains a topic of debate.
  
  
  OBJECTIVE
  We attempted to create a predictive model of complications in patients undergoing spine surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 13,660 patients registered in the American College of Surgeons National Quality Improvement Project (NSQIP) database.
  
  
  METHODS
  Thirty-day postoperative risks of stroke, myocardial infarction, death, infection, urinary tract infection (UTI), deep vein thrombosis (DVT), pulmonary embolism (PE), and return to the operating room.
  
  
  METHODS
  We performed a retrospective cohort study involving patients who underwent spine surgery between 2005 and 2010 and were registered in NSQIP. A model for outcome prediction based on individual patient characteristics was developed.
  
  
  RESULTS
  Of the 13,660 patients, 2,719 underwent anterior approaches (19.9%), 565 corpectomies (4.1%), and 1,757 fusions (12.9%). The respective 30-day postoperative risks were 0.05% for stroke, 0.2% for MI, 0.25% for death, 0.3% for infection, 1.37% for UTI, 0.6% for DVT, 0.29% for PE, and 3.15% for return to the operating room. Multivariate analysis demonstrated that increasing age, more extensive operations (fusion, corpectomy), medical deconditioning (weight loss, dialysis, peripheral vascular disease, coronary artery disease, chronic obstructive pulmonary disease, diabetes), increasing body mass index, non-independent mobilization (preoperative neurologic deficit), and bleeding disorders were independently associated with a more than 3 days' length of stay. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated by the area under the receiver operating characteristic curve, which was 0.95, 0.82, 0.87, 0.75, 0.74, 0.78, 0.76, 0.74, and 0.65 for postoperative risk of stroke, myocardial infarction, death, infection, DVT, PE, UTI, length of stay of 3 days or longer, and return to the operating room, respectively.
  
  
  CONCLUSIONS
  Our model can provide individualized estimates of the risks of postoperative complications based on preoperative conditions, and can potentially be used as an adjunct in decision-making for spine surgery.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756, USA. Electronic address: kbekelis@gmail.com.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756, USA.
authors.forename: Atman
authors.initials: A
authors.lastname: Desai
authors.affiliation: Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Bakhoum
authors.affiliation: Department of Neurosurgery, Portsmouth Hospital, 333 Borthwick Ave., Portsmouth, NH 03801, USA.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009985:Orthopedics / Q000592:standards*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D058996:Quality Improvement; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013131:Spine / Q000601:surgery*
keywords: Anterior approach; Cervical spondylosis; Corpectomy; Lumbar spondylosis; NSQIP; Posterior approach; Risk prediction; Spinal fusion