Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, Japan.
Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan.
Eur Spine J. 2019 Jan;28(1):180-187. doi: 10.1007/s00586-018-5816-5. Epub 2018 Nov 16.
ASD surgery improves a patient's health-related quality of life, but it has a high complication rate. The aim of this study was to create a predictive model for complications after surgical treatment for adult spinal deformity (ASD), using spinal alignment, demographic data, and surgical invasiveness.
This study included 195 surgically treated ASD patients who were > 50 years old and had 2-year follow-up from multicenter database. Variables which included age, gender, BMI, BMD, frailty, fusion level, UIV and LIV, primary or revision surgery, pedicle subtraction osteotomy, spinal alignment, Schwab-SRS type, surgical time, and blood loss were recorded and analyzed at least 2 years after surgery. Decision-making trees for 2-year postoperative complications were constructed and validated by a 7:3 data split for training and testing. External validation was performed for 25 ASD patients who had surgery at a different hospital.
Complications developed in 48% of the training samples. Almost half of the complications developed in late post-op period, and implant-related complications were the most common complication at 2 years after surgery. Univariate analyses showed that BMD, frailty, PSO, LIV, PI-LL, and EBL were risk factors for complications. Multivariate analysis showed that low BMD, PI-LL > 30°, and frailty were independent risk factors for complications. In the testing samples, our predictive model was 92% accurate with an area under the receiver operating characteristic curve of 0.963 and 84% accurate in the external validation.
A successful model was developed for predicting surgical complications. Our model could inform physicians about the risk of complications in ASD patients in the 2-year postoperative period. These slides can be retrieved under Electronic Supplementary Material.
ASD 手术可改善患者的健康相关生活质量，但并发症发生率较高。本研究旨在创建一个预测成人脊柱畸形（ASD）手术治疗后并发症的模型，使用脊柱排列、人口统计学数据和手术侵袭性。
这项研究纳入了 195 名年龄大于 50 岁且接受多中心数据库 2 年随访的接受手术治疗的 ASD 患者。记录并分析了至少 2 年后手术的变量，包括年龄、性别、BMI、BMD、虚弱程度、融合水平、UIV 和 LIV、原发性或修正手术、椎弓根切除截骨术、脊柱排列、Schwab-SRS 类型、手术时间和出血量。使用至少 2 年的术后并发症数据构建和验证决策树，并将其划分为 7:3 的训练和测试数据。对在不同医院接受手术的 25 名 ASD 患者进行外部验证。
训练样本中 48%的患者出现并发症。几乎一半的并发症发生在术后晚期，术后 2 年最常见的并发症是与植入物相关的并发症。单因素分析显示，BMD、虚弱程度、PSO、LIV、PI-LL 和 EBL 是并发症的危险因素。多因素分析显示，低 BMD、PI-LL >30°和虚弱是并发症的独立危险因素。在测试样本中，我们的预测模型的准确性为 92%，ROC 曲线下面积为 0.963，外部验证的准确性为 84%。
成功开发了预测手术并发症的模型。我们的模型可以为医生提供关于 ASD 患者术后 2 年内并发症风险的信息。这些幻灯片可在电子补充材料中检索。
