RT Journal Article SR Electronic T1 Predictors of Complication Severity Following Adult Spinal Deformity Surgery: Smoking Rate, Diabetes, and Osteotomy Increase Risk of Severe Adverse Events JF International Journal of Spine Surgery JO Int J Spine Surg FD International Society for the Advancement of Spine Surgery SP 103 OP 111 DO 10.14444/8393 VO 17 IS 1 A1 Cole A. Bortz A1 Katherine E. Pierce A1 Oscar Krol A1 Nicholas Kummer A1 Lara Passfall A1 Max Egers A1 Cheongeun Oh A1 Samantha R. Horn A1 Frank A. Segreto A1 Dennis Vasquez-Montes A1 Nicholas J. Frangella A1 John A. Buza III A1 Tina Raman A1 Tomas Kuprys A1 Renaud Lafage A1 Pawel P. Jankowski A1 Hamid Hassanzadeh A1 Shaleen N. Vira A1 Bassel G. Diebo A1 Michael C. Gerling A1 Peter G. Passias YR 2023 UL http://ijssurgery.com//content/17/1/103.abstract AB Background Given the physical and economic burden of complications in spine surgery, reducing the prevalence of perioperative adverse events is a primary concern of both patients and health care professionals. This study aims to identify specific perioperative factors predictive of developing varying grades of postoperative complications in adult spinal deformity (ASD) patients, as assessed by the Clavien-Dindo complication classification (Cc) system.Methods Surgical ASD patients ≥18 years were identified in the American College of Surgeons’ National Surgical Quality Improvement Program from 2005 to 2015. Postoperative complications were stratified by Cc grade severity: minor (I, II, and III) and severe (IV and V). Stepwise regression models generated dataset-specific predictive models for Cc groups. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the model. Significance was set at P < 0.05.Results Included were 3936 patients (59 ± 16 years, 63% women, 29 ± 7 kg/m2) undergoing surgery for ASD (4.4 ± 4.7 levels, 71% posterior approach, 11% anterior, and 18% combined). Overall, 1% of cases were revisions, 39% of procedures involved decompression, 27% osteotomy, and 15% iliac fixation. Additionally, 66% of patients experienced at least 1 complication, 0% of which were Cc grade I, 51% II, 5% III, 43% IV, and 1% V. The final model predicting severe Cc (IV–V) complications yielded an AUC of 75.6% and included male sex, diabetes, increased operative time, central nervous system tumor, osteotomy, cigarette pack-years, anterior decompression, and anterior lumbar interbody fusion. Final models predicting specific Cc grades were created.Conclusions Specific predictors of adverse events following ASD-corrective surgery varied for complications of different severities. Multivariate modeling showed smoking rate, osteotomy, diabetes, anterior lumbar interbody fusion, and higher operative time, among other factors, as predictive of severe complications, as classified by the Clavien-Dindo Cc system. These factors can help in the identification of high-risk patients and, consequently, improve preoperative patient counseling.Clinical Relevance The findings of this study provide a foundation for identifying ASD patients at high risk of postoperative complications .Level of Evidence 4.