RT Journal Article
SR Electronic
T1 External Validation of the National Surgical Quality Improvement Program Calculator Utilizing a Single Institutional Experience for Adult Spinal Deformity Corrective Surgery
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8419
DO 10.14444/8419
A1 Sara Naessig
A1 Katherine Pierce
A1 Waleed Ahmad
A1 Lara Passfall
A1 Oscar Krol
A1 Nicholas A. Kummer
A1 Tyler Williamson
A1 Bailey Imbo
A1 Peter Tretiakov
A1 Kevin Moattari
A1 Rachel Joujon-Roche
A1 Jack Zhong
A1 Eaman Balouch
A1 Brooke O’Connell
A1 Constance Maglaras
A1 Bassel Diebo
A1 Renaud Lafage
A1 Virginie Lafage
A1 Shaleen Vira
A1 Steven Hale
A1 Michael Gerling
A1 Themistocles Protopsaltis
A1 Aaron Buckland
A1 Peter G. Passias
YR 2023
UL http://ijssurgery.com//content/early/2023/02/15/8419.abstract
AB Background Identify the external applicability of the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) risk calculator in the setting of adult spinal deformity (ASD) and subsets of patients based on deformity and frailty status.Methods ASD patients were isolated in our single-center database and analyzed for the shared predictive variables displayed in the NSQIP calculator. Patients were stratified by frailty (not frail <0.03, frail 0.3–0.5, severely frail >0.5), deformity [T1 pelvic angle (TPA) > 30, pelvic incidence minus lumbar lordosis (PI-LL) > 20], and reoperation status. Brier scores were calculated for each variable to validate the calculator’s predictability in a single center’s database (Quality). External validity of the calculator in our ASD patients was assessed via Hosmer-Lemeshow test, which identified whether the differences between observed and expected proportions are significant.Results A total of 1606 ASD patients were isolated from the Quality database (48.7 years, 63.8% women, 25.8 kg/m2); 33.4% received decompressions, and 100% received a fusion. For each subset of ASD patients, the calculator predicted lower outcome rates than what was identified in the Quality database. The calculator showed poor predictability for frail, deformed, and reoperation patients for the category “any complication” because they had Brier scores closer to 1. External validity of the calculator in each stratified patient group identified that the calculator was not valid, displaying P values >0.05.Conclusion The NSQIP calculator was not a valid calculator in our single institutional database. It is unable to comment on surgical complications such as return to operating room, surgical site infection, urinary tract infection, and cardiac complications that are typically associated with poor patient outcomes. Physicians should not base their surgical plan solely on the NSQIP calculator but should consider multiple preoperative risk assessment tools.Level of Evidence 3.