Abstract
PurposeThe preoperative prediction of medical complications is essential to optimize perioperative management. SpineSage™ is a free of charge online calculator to predict medical complications in spine surgery. The current study utilizes it in patients undergoing spine surgery to assess whether the predicted risks would correlate with the actual complication rate in clinical practice.MethodsA total of 273 consecutive patients who underwent spinal surgery were assessed. The risk of medical complications was predicted for each patient, and all medical complications were recorded within 30 days of surgery. Based on their predicted risk of complication, patients were divided into three risk groups (< 15, 15–30, > 30%).ResultsThe predicted overall risk of medical complications was 14.7% and was comparable to the observed complication rate of 16.1%. The predicted risk for major medical complications (3.8%) was also similar to the observed complication rate (3.3%). Detailed analysis of the segmented risk groups suggests a close correlation between predicted and actual complication rates. Receiver operating characteristic analysis revealed an area under the curve of 0.71 (p < 0.001) for the prediction of overall medical complications and 0.85 (p < 0.001) for major complications.ConclusionsThe online risk calculator predicted both overall and major medical complications. The tool can assist in preoperative planning and counseling of patients.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Since bundled payment programs often include the reimbursement for complication and readmission, it has become increasingly important to identify patients at risk for perioperative complications [1,2,3,4].1 3 Vol.:(0123456789)European Spine Journal (2018) 27:2449–2456Being able to identify patients at risk for medical and surgical complications helps to better prepare the patient for the procedure based on patient-specific risk factors and invasiveness of the procedure and might help to reduce the overall complication rate
The current study reports the initial clinical experience with this risk assessment tool and analyzes the following research questions: (1) Is there a difference between the predicted overall medical complication rate and the observed complication rate? (2) What is the value of the tool for patients with different risk levels? (3) does the tool have a diagnostic value for the prediction of complication?
At the time of surgery, 33 patients were classified as American Society of Anesthesiologists (ASA) I (12.1%), 152 patients were classified as ASA II (55.7%), followed by 81 patients as ASA III (29.7%) and 7 patients as ASA IV (2.5%)
Summary
Being able to identify patients at risk for medical and surgical complications helps to better prepare the patient for the procedure based on patient-specific risk factors and invasiveness of the procedure and might help to reduce the overall complication rate. Several significant risk factors for medical complications in spine surgery were identified utilizing multivariate analysis [5,6,7]. It is meant to simplify preoperative assessment by taking into consideration patient-specific risk factors as well as the invasiveness of the procedure (Fig. 1). This risk calculator is available online free of charge. It allows the surgeon to calculate the risk for perioperative medical complication for a specific patient and procedure [8]. There are currently no data available that analyze the clinical value of this perioperative risk calculator
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