Utility of Surgical Risk Calculators in Spine Surgery in Patients Aged Over 80 Years: Analysis of SpineSage and ACS NSQIP

Willoughby, James E.; Baker, Joseph F.

doi:10.1177/21925682221074659

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…In that regard, studies of the N-RC have sometimes attributed poor performance to the absence of important operation-specific or other predictors, and comparative studies have sometimes attributed nominal superiority (nominal because of sometimes unresolved issues of research design) of alternative RCs to the inclusion of these predictors. 2 , 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

The Accuracy of the NSQIP Universal Surgical Risk Calculator Compared to Operation-Specific Calculators

Cohen,

Liu,

Hall

et al. 2023

Annals of Surgery Open

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Objective: To compare the performance of the ACS NSQIP “universal” risk calculator (N-RC) to operation-specific RCs. Background: Resources have been directed toward building operation-specific RCs because of an implicit belief that they would provide more accurate risk estimates than the N-RC. However, operation-specific calculators may not provide sufficient improvements in accuracy to justify the costs in development, maintenance, and access. Methods: For the N-RC, a cohort of 5,020,713 NSQIP patient records were randomly divided into 80% for machine learning algorithm training and 20% for validation. Operation-specific risk calculators (OS-RC) and OS-RCs with operation-specific predictors (OSP-RC) were independently developed for each of 6 operative groups (colectomy, whipple pancreatectomy, thyroidectomy, abdominal aortic aneurysm (open), hysterectomy/myomectomy, and total knee arthroplasty) and 14 outcomes using the same 80%/20% rule applied to the appropriate subsets of the 5M records. Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), and Hosmer-Lemeshow (H-L) P values, for 13 binary outcomes, and mean squared error for the length of stay outcome. Results: The N-RC was found to have greater AUROC (P = 0.002) and greater AUPRC (P < 0.001) compared to the OS-RC. No other statistically significant differences in accuracy, across the 3 risk calculator types, were found. There was an inverse relationship between the operation group sample size and magnitude of the difference in AUROC (r = −0.278; P = 0.014) and in AUPRC (r = −0.425; P < 0.001) between N-RC and OS-RC. The smaller the sample size, the greater the superiority of the N-RC. Conclusions: While operation-specific RCs might be assumed to have advantages over a universal RC, their reliance on smaller datasets may reduce their ability to accurately estimate predictor effects. In the present study, this tradeoff between operation specificity and accuracy, in estimating the effects of predictor variables, favors the N-R, though the clinical impact is likely to be negligible.

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Section: Introductionmentioning

confidence: 99%

The Accuracy of the NSQIP Universal Surgical Risk Calculator Compared to Operation-Specific Calculators

Cohen,

Liu,

Hall

et al. 2023

Annals of Surgery Open

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The Evolution of Risk Assessment in Spine Surgery: A Narrative Review

Ton,

Wishart,

Ball

et al. 2024

World Neurosurgery

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Comparison of RVU Reimbursement in Anterior or Posterior Approach for Single- and Multilevel Cervical Spinal Fusion

Asthana,

Bajaj,

Staub

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective database study. Objective: This study aims to quantify and compare mean work RVUs (wRVUs), mean operative time (OpTime), and wRVUs/min in single- and multilevel anterior and posterior cervical spine fusions performed between 2011 and 2020. Summary of Background Data: Prior research has demonstrated inconsistencies in technical skill, operative time, and surgical difficulty with reimbursement in various orthopedic subspecialties. Although trends investigating physician effort and reimbursement have been investigated in lumbar spine surgery, less research has examined these relationships with respect to cervical spine procedures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried for Current Procedural Terminology (CPT) codes reflecting anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and the number of levels involved. The cohort was stratified into 10 groups: single-level, 2-level, 3-level, 4-level, 5+ level anterior or posterior cervical fusions. Mean operative times, mean wRVUs, and wRVU/min were calculated and compared by Student t test. Results: A total of 100,997 patients met inclusion criteria in this study, of which 79,141 (78.36%) underwent ACDF, whereas 21,836 (21.62%) underwent PCDF. One- and 2-level fusions were most common in both ACDF and PCDF. In 1-, 3-, 4-, and 5+ level fusion, the anterior approach demonstrated significantly lower mean wRVU (P<0.001). In 1-, 2-, and 3-level fusions, the anterior approach had significantly lower operation times (P<0.001). The anterior approach demonstrated significantly higher wRVU/min in 1- and 2- levels (P<0.001) but lower wRVU/min in 3- and 4-level fusions (P<0.001). Conclusions: Clear discrepancies exist between surgical approach and levels of fusion in cervical spine procedures incongruous with markers of surgical difficulty, physician effort, or expertise required. These specific results suggest that the complexity of multi-level anterior cervical fusions are not effectively accounted for by existing RVU measures.

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Utility of Surgical Risk Calculators in Spine Surgery in Patients Aged Over 80 Years: Analysis of SpineSage and ACS NSQIP

Cited by 4 publications

References 22 publications

The Accuracy of the NSQIP Universal Surgical Risk Calculator Compared to Operation-Specific Calculators

The Accuracy of the NSQIP Universal Surgical Risk Calculator Compared to Operation-Specific Calculators

The Evolution of Risk Assessment in Spine Surgery: A Narrative Review

Comparison of RVU Reimbursement in Anterior or Posterior Approach for Single- and Multilevel Cervical Spinal Fusion

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