Assessing The Impact of High-Risk Committees In Adult Cervical Deformity Corrective Surgery: Review of Outcomes, Complications, And Frequency of Procedures Receiving Multidisciplinary Evaluation

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
OO

Oluwatobi Onafowokan

United Kingdom
JL

Jordan Lebovic, MD, MBA

Resident
NYU Langone Orthopedics
New York, New York, United States
DR

Djani Robertson

Resident Physician, United States
BD

Bassel Diebo, MD

Spine Surgeon
Brown University
Brooklyn, Rhode Island, United States
SV

Shaleen Vira, MD

Assistant Professor, Orthopaedic Surgery & Neurosurgery
UT Southwestern Medical Center
Dallas, Texas, United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: To prevent or minimize the occurance of never-events and complications, some institutions have implemented pre-operative multidisciplinary committees tasked with reviewing the safety and utility of such procedures. However, the utility of such committees remains understudied.

Purpose: To assess the frequency, outcomes, and impact of high-risk procedures receiving pre-operative multidisciplinary review at a major urban academic medical center.

Methods: CD patients ≥18yrs with complete pre-(BL) and 2-year(2Y) postop radiographic/HRQL data were stratified as necessitating high-risk review by senior spine surgeon and anaesthesiologists versus not (HRR+ vs HRR-). High risk patients were defined by meeting any of the following criteria: 1) anterior-posterior CD fusion ≥3 levels, 2) planned 3-column osteotomy, VCR, and/or ACR 3) deformity correction with severe BL neurological deficit 4) severe BL myelopathy (mJOA < 11), 5) severe osteoporosis with fusion ≥4 levels. Differences in demographics, radiographic, and complication rates were assessed via means comparison. Adjusting for BL age and mACD-FI, follow up univariate one-way ANCOVAs were performed to assess post-operative outcomes. Logistic regressions adjusting for BL age, mACD-FI, and date of surgery, and BL TS-CL and cSVA assessed impact of committee review on prediction of complications or reoperation. Linear regression assessed frequency of HR procedures by DOS.

Results: Of 149 CD patients (57.5±10.9 years, 58.2% female, 28.5±7.8 kg/m2), and 51.0% (n=76) underwent committee review. At baseline, HR+ patients were more frail per mACD-FI (p <.001). HRR+ patients were also were also significantly more likely to have a history of myocardial infarction (p=.045). Peri-operatively, HRR+ patients had significantly higher mean operative time (p <.001), and were more likely to undergo osteotomy (p=.020) or 3CO (p=.045), though EBL, length of stay, SICU admissions, and discharge dispositions were comparable (all p>.05). Rates of any complications and mortality were also comparable between groups (all p>.05), though HRR+ were significantly more likely to experience peri-operative cardiopulmonary complications (p=.033). DJK rates by 2Y were also higher in HR+ patients. However, HRR- patients reported significantly higher reoperation rates (p=.037). Yet, adjusted regression revealed that HRR was not independently predictive of major complications, nor reoperation (all p>.05). Backstep linear regression accounting for BL age and gender found a significant negative correlation between increasing date of surgery and frequency of HR cases (model p=.009).

Conclusions: Multidisciplinary committee review of high-risk adult cervical deformity procedures has risen in popularity at certain institutions as a method of reducing complications and associated physiological and cost burden. The present study reveals that implementation of high-risk committee is associated with a lower frequency of high-risk procedures over time. Despite these findings, increased peri-operative cardiopulmonary complications in high-risk patients suggests that the risk of adverse events is not necessarily diminished after establishment of such committees.