Passias Peter G, Naessig Sara, Para Ashok, Pierce Katherine, Ahmad Waleed, Diebo Bassel G, Lafage Renaud, Lafage Virginie, Smith Justin S, Janjua Burhan
Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA
Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA.
Int J Spine Surg. 2022 Jul 31;16(4):760-6. doi: 10.14444/8245.
The International Spine Study Group (ISSG) and the European Spine Study Group (ESSG) developed an adult spinal deformity (ASD) risk calculator based on one of the most granular, prospective ASD databases. The calculator utilizes preoperative radiographic, surgical, and patient-specific variables to predict patient-reported outcomes and complication rates at 2 years. Our aim was to assess the ISSG-ESSG risk calculator's usability in a single-institution ASD population.
Frail ([F], 0.3 > 0.5) ASD patients were isolated in a single-center ASD database. Basic demographics were assessed via and tests. Each F patient was inputted into the ESSG risk calculator to identify individual predictive rates for postoperative 2-year health-related quality of life questions (HRQL) outcomes and major complications. These calculated predicted outcomes were analyzed against those identified from the ASD database in order to validate the calculator's predictability via Brier scores. A score closer to 1 meant the ISSG-ESSG calculator was not predictive of that specific outcome. A score closer to 0 meant the ISSG-ESSG calculator was a predictive tool for that factor.
A total of 631 ASD patients were isolated (55.8 ± 16.8 years, 26.68 kg/m, 0.95 ± 1.3 Charlson Comorbidity Index). Of those patients, 7.8% were frail. Fifty percent of frail patients received an interbody fusion, 58.3% received a decompression, and 79.2% underwent osteotomy. Surgical details were as follows: mean operative time was 342.9 ± 94.3 minutes, mean estimated blood loss was 2131.82 ± 1011 mL, and average length of stay was 7.12 ± 2.5 days. The ISSG-ESSG calculator predicted the likelihood of improvement for the following HRQL's: Oswestry Disability Index (ODI) (86%), Scoliosis Research Society (SRS)-22 mental health (71.1%), SRS-22 total (87.6%), and major complication (53.4%). The single institution had lower percentages of improvement in ODI (24.6%), SRS-22 mental health (21.3%), SRS-22 total (25.1%), and lower presence of major complication (34.8%). The calculated Brier scores identified the calculator's predictability for each factor was as follows: ODI (0.24), SRS-22 mental health (0.21), SRS-22 total (0.25), and major complication (0.28).
All of the variables had low Brier scores, indicating that the ISSG-ESSG calculator can be used as a predictive tool for ASD frail patients.
国际脊柱研究小组（ISSG）和欧洲脊柱研究小组（ESSG）基于最详细的前瞻性成人脊柱畸形（ASD）数据库之一，开发了一种成人脊柱畸形风险计算器。该计算器利用术前影像学、手术及患者特定变量来预测患者报告的2年结局及并发症发生率。我们的目的是评估ISSG - ESSG风险计算器在单机构ASD患者群体中的可用性。
在单中心ASD数据库中筛选出虚弱（[F]，0.3 > 0.5）的ASD患者。通过 和 检验评估基本人口统计学特征。将每位F患者输入ESSG风险计算器，以确定术后2年健康相关生活质量问题（HRQL）结局和主要并发症的个体预测率。将这些计算出的预测结局与ASD数据库中确定的结局进行分析，以通过Brier评分验证计算器的预测性。分数越接近1意味着ISSG - ESSG计算器对该特定结局无预测性。分数越接近0意味着ISSG - ESSG计算器是该因素的预测工具。
共筛选出631例ASD患者（55.8 ± 16.8岁，26.68 kg/m，Charlson合并症指数0.95 ± 1.3）。其中，7.8%为虚弱患者。50%的虚弱患者接受了椎间融合术，58.3%接受了减压术，79.2%接受了截骨术。手术细节如下：平均手术时间为342.9 ± 94.3分钟，平均估计失血量为2131.82 ± 1011 mL，平均住院时间为7.12 ± 2.5天。ISSG - ESSG计算器预测以下HRQL改善的可能性：Oswestry功能障碍指数（ODI）（86%）、脊柱侧凸研究学会（SRS）- 22心理健康（71.1%）、SRS - 22总分（87.6%）和主要并发症（53.4%）。单机构中ODI改善百分比（24.6%）、SRS - 22心理健康（21.3%）、SRS - 22总分（25.1%）较低，主要并发症发生率也较低（34.8%）。计算出的Brier评分确定计算器对各因素的预测性如下：ODI（0.24）、SRS - 22心理健康（0.21）、SRS - 22总分（0.25）和主要并发症（0.28）。
所有变量的Brier评分均较低，表明ISSG - ESSG计算器可作为ASD虚弱患者的预测工具。
