RT Journal Article
SR Electronic
T1 Predictive Analytics for Determining Extended Operative Time in Corrective Adult Spinal Deformity Surgery
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 291
OP 299
DO 10.14444/8174
VO 16
IS 2
A1 Peter G. Passias
A1 Gregory W. Poorman
A1 Dennis Vasquez-Montes
A1 Nicholas Kummer
A1 Gregory Mundis
A1 Neel Anand
A1 Samantha R. Horn
A1 Frank A. Segreto
A1 Lara Passfall
A1 Oscar Krol
A1 Bassel Diebo
A1 Doug Burton
A1 Aaron Buckland
A1 Michael Gerling
A1 Alex Soroceanu
A1 Robert Eastlack
A1 D. Kojo Hamilton
A1 Robert Hart
A1 Frank Schwab
A1 Virginie Lafage
A1 Christopher Shaffrey
A1 Daniel Sciubba
A1 Shay Bess
A1 Christopher Ames
A1 Eric Klineberg
A1 On behalf of the International Spine Study Group
YR 2022
UL http://ijssurgery.com//content/16/2/291.abstract
AB Background More sophisticated surgical techniques for correcting adult spinal deformity (ASD) have increased operative times, adding to physiologic stress on patients and increased complication incidence. This study aims to determine factors associated with operative time using a statistical learning algorithm.Methods Retrospective review of a prospective multicenter database containing 837 patients undergoing long spinal fusions for ASD. Conditional inference decision trees identified factors associated with skin-to-skin operative time and cutoff points at which factors have a global effect. A conditional variable-importance table was constructed based on a nonreplacement sampling set of 2000 conditional inference trees. Means comparison for the top 15 variables at their respective significant cutoffs indicated effect sizes.Results Included: 544 surgical ASD patients (mean age: 58.0 years; fusion length 11.3 levels; operative time: 378 minutes). The strongest predictor for operative time was institution/surgeon. Center/surgeons, grouped by decision tree hierarchy, a and b were, on average, 2 hours faster than center/surgeons c-f, who were 43 minutes faster than centers g-j, all P < 0.001. The next most important predictors were, in order, approach (combined vs posterior increases time by 139 minutes, P < 0.001), levels fused (<4 vs 5–9 increased time by 68 minutes, P < 0.050; 5–9 vs < 10 increased time by 47 minutes, P < 0.001), age (age <50 years increases time by 57 minutes, P < 0.001), and patient frailty (score <1.54 increases time by 65 minutes, P < 0.001). Surgical techniques, such as three-column osteotomies (35 minutes), interbody device (45 minutes), and decompression (48 minutes), also increased operative time. Both minor and major complications correlated with <66 minutes of increased operative time. Increased operative time also correlated with increased hospital length of stay (LOS), increased estimated intraoperative blood loss (EBL), and inferior 2-year Oswestry Disability Index (ODI) scores.Conclusions Procedure location and specific surgeon are the most important factors determining operative time, accounting for operative time increases <2 hours. Surgical approach and number of levels fused were also associated with longer operative times, respectively. Extended operative time correlated with longer LOS, higher EBL, and inferior 2-y ODI outcomes.Clinical Relevance We further identified the poor outcomes associated with extended operative time during surgical correction of ASD, and attributed the useful predictors of time spent in the operating room, including site, surgeon, surgical approach, and the number of levels fused.Level of Evidence 3.