Predictive Analytics for Determining Extended Operative Time in Corrective Adult Spinal Deformity Surgery.
Publication Title
Int J Spine Surg
Document Type
Article
Publication Date
4-1-2022
Keywords
washington; swedish neuro; swedish
Abstract
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
CONCLUSIONS: Procedure location and specific surgeon are the most important factors determining operative time, accounting for operative time increasestimes, 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.
Clinical Institute
Neurosciences (Brain & Spine)
Clinical Institute
Orthopedics & Sports Medicine
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Orthopedics
