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Research ArticleComplications

Validation of the ACS-NSQIP Risk Calculator: A Machine-Learning Risk Tool for Predicting Complications and Mortality Following Adult Spinal Deformity Corrective Surgery

Katherine E. Pierce, Bhaveen H. Kapadia, Sara Naessig, Waleed Ahmad, Shaleen Vira, Carl Paulino, Michael Gerling and Peter G. Passias
International Journal of Spine Surgery December 2021, 15 (6) 1210-1216; DOI: https://doi.org/10.14444/8153
Katherine E. Pierce
1 Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA
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Bhaveen H. Kapadia
2 Department of Orthopedic Surgery, SUNY Downstate Medical School, Brooklyn, New York, USA
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Sara Naessig
1 Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA
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Waleed Ahmad
1 Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA
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Shaleen Vira
3 Department of Orthopedic Surgery, UT Southwestern, Dallas, New York, USA
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Carl Paulino
2 Department of Orthopedic Surgery, SUNY Downstate Medical School, Brooklyn, New York, USA
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Michael Gerling
4 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
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Peter G. Passias
1 Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York, USA
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    Bland-Altman plot demonstrating predictive performance for hospital length of stay.

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    Table 1

    National Surgical Quality Improvement Program (NSQIP) calculator factors for patients in the adult spinal deformity (ASD) cohort.

    NSQIP Factor% Cohort
    (N = 9143)
    Age, years, mean58.94
    Females56%
    Functional status
     Independent94.9%
     Partially dependent4.4%
     Totally dependent0.7%
    Emergency cases1.6%
    Wound class
     Clean94.7%
     Clean/contaminated0.8%
     Contaminated0.5%
     Dirty/infected1.4%
    ASA class
     I2.7%
     II40.7%
     III52.0%
     IV4.6%
     V0%
     None assigned0%
    Steroid use for chronic condition5.1%
    Ascites within 30 d before surgery<0.1%
    Systemic sepsis within 48 h of surgery1.7%
    Ventilator dependent0.4%
    Disseminated cancer3.2%
    Diabetes15.6%
    Use of hypertensive medications52.8%
    CHF within 30 d before surgery0.3%
    Dyspnea3.0%
    History of smoking within 1 y21.4%
    Severe COPD4.3%
    Dialysis0.7%
    Acute renal failure0.1%
    • ASA, American Society of Anesthesiologists; ASD, adult spinal deformity; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; NSQIP, National Surgical Quality Improvement Program.

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    Table 2

    Predicted percentages from the NSQIP calculator and observed percentages from the actual cohort of perioperative outcomes, as well as the Brier score and Brier max between the predicted and observed percentages.

    ComplicationPredicted, %Observed, %Brier ScoreBrier Max
    Serious complication10.4810.10.000014440.090799
    Any complication11.5411.40.000001960.101004
    Pneumonia1.222.40.000139240.023424
    Cardiac complication0.340.90.000031360.008919
    SSI2.041.85.76E-060.017676
    UTI1.692.70.000102010.026271
    VTE1.552.30.000056250.022471
    Renal failure0.230.29E-080.001996
    Readmission5.696.68.281E-050.061644
    Return to OR3.903.80.0000010.036556
    Death0.280.90.000038440.008919
    Discharge to nursing or rehabilitation20.552.640.003422250.194304
    Sepsis1.281.80.000027040.017676
    • NSQIP, National Surgical Quality Improvement Program; OR, operating room; SSI, surgical site infection; UTI, urinary tract infection; VTE, venous thromboembolism.

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International Journal of Spine Surgery
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Validation of the ACS-NSQIP Risk Calculator: A Machine-Learning Risk Tool for Predicting Complications and Mortality Following Adult Spinal Deformity Corrective Surgery
Katherine E. Pierce, Bhaveen H. Kapadia, Sara Naessig, Waleed Ahmad, Shaleen Vira, Carl Paulino, Michael Gerling, Peter G. Passias
International Journal of Spine Surgery Dec 2021, 15 (6) 1210-1216; DOI: 10.14444/8153

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Validation of the ACS-NSQIP Risk Calculator: A Machine-Learning Risk Tool for Predicting Complications and Mortality Following Adult Spinal Deformity Corrective Surgery
Katherine E. Pierce, Bhaveen H. Kapadia, Sara Naessig, Waleed Ahmad, Shaleen Vira, Carl Paulino, Michael Gerling, Peter G. Passias
International Journal of Spine Surgery Dec 2021, 15 (6) 1210-1216; DOI: 10.14444/8153
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