As I suspected, 5 of the top 6 predictors of complications were associated entirely with the patient. Only anterior approach is under the control of surgeons.

The knee-jerk reaction to blame the surgeon when something bad happens is not supported by this research. These guys are just taking these patients as they come and trying to help. I hope people take this on board.

The Fusion Risk Score: Evaluating Baseline Risk in Thoracic and Lumbar Fusion Surgery

Hartin, Nathan L.; Mehbod, Amir A.; Joglekar, Siddharth B.; More

Spine., POST ACCEPTANCE, 21 August 2013

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Study Design. Retrospective cohort study

Objective. The Fusion Risk Score is introduced to assess baseline risk of spine fusion surgery preoperatively. An objective method of stratifying risk allows the surgeon to control risk through tailoring intervention and explain differences in complication profile in high-complexity practice.

Summary of Background Data. Research has identified an elevated risk of serious complications performing spine fusion surgery in the elderly, yet the rate of such surgery continues to increase. A range of comorbidities and surgical factors are demonstrated predictors of perioperative risk.

Methods. Retrospective review was made of 364 consecutive fusion surgeries in patients over age 65 in an 18 month period. Logistic regression analysis was performed to identify factors predictive for the occurrence of perioperative events. The predictive variables were incorporated in a weighted fashion into the Fusion Risk Score (FRS) scaled from 1 to 20. Patient demographics and co-morbidities were incorporated into the FRS Patient Score (maximum 10) and surgical approach, levels and osteotomies into the FRS Procedure Score (maximum 10).

Results. Multivariate analysis demonstrated chronic kidney disease (OR = 5.3, 95% CI 1.5-18.6, p = 0.008), chronic obstructive pulmonary disease (OR = 5.3, 95% CI 2.0-14.2, p<0.001), ischemic heart disease (OR = 4.1, 95% CI 2.0-8.4, p<0.001), an open anterior approach (OR = 3.6, 95% CI 1.4-9.3, p = 0.010), diabetes (OR = 3.0, 95% CI 1.4-6.4, p = 0.004), previous spinal surgery at the same site (OR = 2.6, 95% CI 1.3-4.9, p = 0.005), age (OR = 1.07, 95% CI 1.01-1.13, p = 0.019) and the number of motion segments fused (p = 0.049) to be predictive of perioperative events. When applied, the FRS was highly predictive of perioperative events, ICU admission, operative time, blood loss and length of stay (all p<0.0001). A score over threshold 9 carries a greater than 50% risk of perioperative events.

Conclusions. The Fusion Risk Score predicts the risk of complications after spine fusion surgery based on patient and surgery characteristics. It also predicts the risk of ICU admission and correlates with operative time, blood loss and postoperative length of stay. By balancing the FRS Procedure Score to the individual FRS Patient Score, the surgeon can quantify and control perioperative risk.

(C) 2013 by Lippincott Williams & Wilkins