The ISSG-AO Complication Intervention Score, but Not Major/Minor Designation, is Correlated With Length of Stay Following Adult Spinal Deformity Surgery.
Global Spine J
washington; swedish; swedish neuro; adult spinal deformity; classification; complications; deformity; degenerative; grading; length of stay; lumbar; major; minor; neurologic; scoliosis; spine; thoracic
STUDY DESIGN: Retrospective review.
OBJECTIVES: The International Spine Study Group-AO (ISSG-AO) Adult Spinal Deformity (ASD) Complication Classification System was developed to improve classification, reporting, and study of complications among patients undergoing ASD surgery. The ISSG-AO system classifies interventions to address complications by level of invasiveness: grade zero (none); grade 1, mild (e.g., medication change); grade 2, moderate (e.g., ICU admission); grade 3, severe (e.g., reoperation related to surgery of interest). To evaluate the efficacy of the ISSG-AO ASD Complication Classification System, we aimed to compare correlations between postoperative length of stay (LOS) and complication severity as classified by the ISSG-AO ASD and traditional major/minor complication classification systems.
METHODS: Patients age ≥18 in a multicenter ASD database who sustained in-hospital complications were identified. Complications were classified with the major/minor and ISSG-AO systems and correlated with LOS using an ensemble-based machine learning algorithm (conditional random forest) and a generalized linear mixed model.
RESULTS: 490 patients at 19 sites were included. 64.9% of complications were major, and 35.1% were minor. By ISSG-AO classification, 20.4%, 66.1%, 6.7%, and 6.7% were grades 0-3, respectively. ISSG-AO complication grading demonstrated significant correlation with LOS, whereas major/minor complication classification demonstrated inverse correlation with LOS. In conditional random forest analysis, ISSG-AO classification had the greatest relative importance when assessing correlations across multiple variables with LOS.
CONCLUSIONS: The ISSG-AO system may help identify specific complications associated with prolonged LOS. Targeted interventions to avoid or reduce these complications may improve ASD surgical quality and resource utilization.
Neurosciences (Brain & Spine)
Orthopedics & Sports Medicine
Wick, Joseph B; Blandino, Andrew; Smith, Justin S; Line, Breton G; Lafage, Virginie; Lafage, Renaud; Kim, Han Jo; Passias, Peter G; Gum, Jeffrey L; Kebaish, Khaled M; Eastlack, Robert K; Daniels, Alan; Mundis, Gregory; Hostin, Richard; Protopsaltis, Themistocles; Hamilton, D Kojo; Kelly, Michael P; Gupta, Munish; Hart, Robert A; Schwab, Frank J; Burton, Douglas C; Ames, Christopher P; Lenke, Lawrence G; Shaffrey, Christopher I; Bess, Shay; Klineberg, Eric; and International Spine Study Group, "The ISSG-AO Complication Intervention Score, but Not Major/Minor Designation, is Correlated With Length of Stay Following Adult Spinal Deformity Surgery." (2023). Articles, Abstracts, and Reports. 7844.