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Surgeons’ risk perception in ASD surgery: The value of objective risk assessment on decision making and patient counselling

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Abstract

Background

Surgeons often rely on their intuition, experience and published data for surgical decision making and informed consent. Literature provides average values that do not allow for individualized assessments. Accurate validated machine learning (ML) risk calculators for adult spinal deformity (ASD) patients, based on 10 year multicentric prospective data, are currently available. The objective of this study is to assess surgeon ASD risk perception and compare it to validated risk calculator estimates.

Methods

Nine ASD complete (demographics, HRQL, radiology, surgical plan) preoperative cases were distributed online to 100 surgeons from 22 countries. Surgeons were asked to determine the risk of major complications and reoperations at 72 h, 90 d and 2 years postop, using a 0–100% risk scale. The same preoperative parameters circulated to surgeons were used to obtain ML risk calculator estimates. Concordance between surgeons’ responses was analyzed using intraclass correlation coefficients (ICC) (poor < 0.5/excellent > 0.85). Distance between surgeons’ and risk calculator predictions was assessed using the mean index of agreement (MIA) (poor < 0.5/excellent > 0.85).

Results

Thirty-nine surgeons (74.4% with > 10 years’ experience), from 12 countries answered the survey. Surgeons’ risk perception concordance was very low and heterogeneous. ICC ranged from 0.104 (reintervention risk at 72 h) to 0.316 (reintervention risk at 2 years). Distance between calculator and surgeon prediction was very large. MIA ranged from 0.122 to 0.416. Surgeons tended to overestimate the risk of major complications and reintervention in the first 72 h and underestimated the same risks at 2 years postop.

Conclusions

This study shows that expert surgeon ASD risk perception is heterogeneous and highly discordant. Available validated ML ASD risk calculators can enable surgeons to provide more accurate and objective prognosis to adjust patient expectations, in real time, at the point of care.

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Acknowledgements

The International Spine Study Group Foundation receives funding support from DePuy Synthes, K2M, Nuvasive, Orthofix and Zimmer Biomet. The European Spine Study Group receives funding support from DePuy Synthes and Medtronic.

Funding

The research groups receive funding support from DePuy Synthes, Medtronic K2M, Nuvasive, Orthofix and Zimmer Biomet.

Author information

Authors and Affiliations

  1. Spine Surgery Unit, Vall d’Hebron University Hospital, Barcelona, Spain

    Ferran Pellisé, Susana Núñez-Pereira & Sleiman Haddad

  2. Spine Research Unit, Vall d’Hebron Research Institute, Barcelona, Spain

    Alba Vila-Casademunt

  3. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA

    Justin S. Smith

  4. Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA

    Michael P. Kelly & Munish Gupta

  5. Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey

    Ahmet Alanay & Çaglar Yilgor

  6. Duke University Medical Center, Durham, NC, USA

    Christopher Shaffrey

  7. Spine Surgery Unit, La Paz University Hospital, Madrid, Spain

    Javier Pizones & Francisco J. Sánchez Pérez-Grueso

  8. Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France

    Ibrahim Obeid

  9. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA

    Douglas Burton

  10. Spine Center Division, Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstück, Tamas Fekete & Markus Loibl

  11. Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, CO, USA

    Shay Bess

  12. Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA

    Eric O. Klineberg

  13. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

    Miquel Serra-Burriel

  14. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA

    Christopher P. Ames

Authors
  1. Ferran Pellisé
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  2. Alba Vila-Casademunt
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  7. Ahmet Alanay
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  12. Douglas Burton
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  15. Shay Bess
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  19. Francisco J. Sánchez Pérez-Grueso
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European Spine Study Group, International Spine Study Group

Corresponding author

Correspondence to Ferran Pellisé.

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Conflict of interest

Dr. Alanay reports grants from Medtronic, grants from Depuy Synthes, personal fees from Globus Medical, personal fees from Zimmer Biomet, outside the submitted work. Dr. Vila-Casademunt has nothing to disclose. Dr. Ames reports personal fees from UCSF, personal fees from Stryker, personal fees from Biomet Zimmer Spine, personal fees from DePuy Synthes, personal fees from Nuvasive, personal fees from Next Orthosurgical, personal fees from K2M, personal fees from Medicrea, personal fees from Titan Spine, personal fees from Medtronic, personal fees from ISSG, personal fees from Operative Neurosurgery, personal fees from SRS, personal fees from Global Spinal Analytics, outside the submitted work. Dr. Shaffrey reports grants from ISSG Foundation, during the conduct of the study; other from Nuvasive, other from Medtronic, other from SI Bone, other from Zimmer Biomet, outside the submitted work. Dr. Yilgor has nothing to disclose. Dr. Burton reports grants, personal fees and other from DePuy Synthes, other from Progenerative Medical, non-financial support from ISSG, non-financial support from SRS, other from Bioventus, other from Pzifer, outside the submitted work. Dr. Klineberg reports personal fees from Depuy Synthes, personal fees from Stryker, personal fees from Medicrea/Medtronic, grants and personal fees from AO Spine, outside the submitted work. Dr. ESSG reports grants from Depuy Synthes, grants from Medtronic, outside the submitted work. Dr. Kleinstück reports other from Depuy Synthes Spine, during the conduct of the study. Dr. Pellisé reports grants from Depuy Synthes Spine, grants and other from Medtronic, other from Nuvasive, outside the submitted work. Dr. Sánchez Pérez-Grueso has nothing to disclose. Dr. Obeid reports grants from depuy synthes, during the conduct of the study; personal fees from depuy synthes, personal fees from medtronic, personal fees from clariance, personal fees from spineart, personal fees from alphatec, outside the submitted work. Dr. ISSG reports grants from DePuy Synthes Spine, grants from K2M/Stryker, grants from NuVasive, grants from Orthofix, grants from Allosource, grants from BI Bone, during the conduct of the study; grants from Medtronic, grants from Stryker, grants from Globus, outside the submitted work. Dr. Gum reports grants from Intellirod, grants from NuVasive, grants from Integra, grants from Pfizer, grants from ISSG, grants from Norton Healthcare, during the conduct of the study; personal fees from Acuity, personal fees from Medtronic, personal fees from Depuy, personal fees from K2M/Stryker, personal fees from NuVasive, outside the submitted work; In additon, Dr. Gum has a patent Medtronic pending. Dr. Pizones reports grants from Depuy Synthes, grants and other from Medtronic, other from Stryker, during the conduct of the study. Dr. Smith reports grants from DePuy Synthes/ISSGF, during the conduct of the study; personal fees from Stryker, personal fees from Cerapedics, other from Carlsmed, personal fees from Zimmer Biomet, grants, personal fees and other from NuVasive, personal fees from Thieme, grants from NREF, grants from AOSpine, grants and personal fees from DePuy Synthes, other from Alphatec, other from Scoliosis Research Society, outside the submitted work. Dr. Gupta reports personal fees, non-financial support and other from DePuy, personal fees from Innomed, personal fees and non-financial support from Globus, personal fees and non-financial support from Medtronic, other from J&J, other from P&G, non-financial support from Scoliosis Research Society, personal fees and non-financial support from AO Spine, non-financial support from Mizuho, non-financial support from Medicrea, personal fees and non-financial support from Alphatec, outside the submitted work. Dr. Kelly has nothing to disclose. Dr. Loibl has nothing to disclose. Dr. Serra-Buriel ahs nothing to dislcose. Dr. bess reports grants from depuy synthes, grants from nuvasive, grants from k2 stryker, grants from ISSGF, during the conduct of the study; grants and other from K2 stryker, grants from medtronic, grants from globus, grants from sea spine, grants from si bone, outside the submitted work. Dr. Haddad has nothing to dislcose. Dr. Núñez-Pereira has nothing to disclose. Dr. Fekete has nothing to disclose.

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Pellisé, F., Vila-Casademunt, A., Núñez-Pereira, S. et al. Surgeons’ risk perception in ASD surgery: The value of objective risk assessment on decision making and patient counselling. Eur Spine J 31, 1174–1183 (2022). https://doi.org/10.1007/s00586-022-07166-2

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  • DOI: https://doi.org/10.1007/s00586-022-07166-2

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