Gendreau Julian L, Nguyen Andrew, Brown Nolan J, Pennington Zach, Lopez Alexander M, Patel Neal, Chakravarti Sachiv, Kuo Cathleen, Camino-Willhuber Gaston, Albano Stephen, Osorio Joseph A, Oh Michael Y, Pham Martin H
Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA.
College of Medicine, University of Florida, Gainesville, Florida, USA.
World Neurosurg. 2023 Sep;177:e600-e612. doi: 10.1016/j.wneu.2023.06.109. Epub 2023 Jun 30.
Since its proposal, the Global Alignment and Proportion (GAP) score has been the topic of several external validation studies, which have yielded conflicting results. Given the lack of consensus regarding this prognostic tool, the authors aim to assess the accuracy of GAP scores for predicting mechanical complications following adult spinal deformity correction surgery.
A systematic search was performed using PubMed, Embase, and Cochrane Library for the purpose of identifying all studies evaluating the GAP score as a predictive tool for mechanical complications. GAP scores were pooled using a random-effects model to compare patients reporting mechanical complications after surgery versus those reporting no complications. Where receiver operator curves were provided, the area under the curve (AUC) was pooled.
A total of 15 studies featuring 2092 patients were selected for inclusion. Qualitative analysis using Newcastle-Ottawa criteria revealed moderate quality among all included studies (5.99/9). With respect to sex, the cohort was predominantly female (82%). The pooled mean age among all patients in the cohort was 58.55 years, with a mean follow-up of 33.86 months after surgery. Upon pooled analysis, we found that mechanical complications were associated with higher mean GAP scores, albeit minimal (mean difference = 0.571 [ 95% confidence interval: 0.163-0.979]; P = 0.006, n = 864). Additionally, age (P = 0.136, n = 202), fusion levels (P = 0.207, n = 358), and body mass index (P = 0.616, n = 350) were unassociated with mechanical complications. Pooled AUC revealed poor discrimination overall (AUC = 0.69; n = 1206).
GAP scores may have a minimal-to-moderate predictive capability for mechanical complications associated with adult spinal deformity correction.
自全球对齐与比例（GAP）评分提出以来，它一直是多项外部验证研究的主题，这些研究得出了相互矛盾的结果。鉴于关于这一预后工具缺乏共识，作者旨在评估GAP评分预测成人脊柱畸形矫正手术后机械并发症的准确性。
使用PubMed、Embase和Cochrane图书馆进行系统检索，以识别所有评估GAP评分作为机械并发症预测工具的研究。使用随机效应模型汇总GAP评分，以比较术后报告有机械并发症的患者与报告无并发症的患者。若提供了受试者工作特征曲线，则汇总曲线下面积（AUC）。
共纳入15项研究，涉及2092例患者。使用纽卡斯尔-渥太华标准进行的定性分析显示，所有纳入研究的质量中等（5.99/9）。在性别方面，队列中女性占主导（82%）。队列中所有患者的汇总平均年龄为58.55岁，术后平均随访33.86个月。经汇总分析，我们发现机械并发症与较高的平均GAP评分相关，尽管差异很小（平均差=0.571 [95%置信区间：0.163 - 0.979]；P = 0.006，n = 864）。此外，年龄（P = 0.136，n = 202）、融合节段数（P = 0.207，n = 358）和体重指数（P = 0.616，n = 350）与机械并发症无关。汇总的AUC显示总体区分能力较差（AUC = 0.69；n = 1206）。
GAP评分对成人脊柱畸形矫正相关机械并发症的预测能力可能为低到中等。
