Assessing the impact of high-risk committees in adult cervical deformity corrective surgery: a retrospective review of outcomes, complications, and frequency of procedures receiving preoperative multidisciplinary evaluation.

Abstract

Objective: The objective was to assess the frequency, outcomes, and impact of high-risk procedures receiving preoperative multidisciplinary review in adult cervical deformity (ACD) patients.

Methods: ACD patients were stratified by whether they underwent high-risk review (HRR). High-risk patients were defined as meeting ≥ 1 of the following criteria: anterior-posterior cervical deformity fusion ≥ 3 levels; planned 3-column osteotomy, vertebral column resection, and/or anterior column refinement; deformity correction with severe baseline neurological deficit; severe baseline myelopathy (modified Japanese Orthopaedic Association score < 11); and severe osteoporosis with fusion ≥ 4 levels. Differences in demographic characteristics, radiographic outcomes, and complication rates were assessed via means comparison. Adjusting for baseline age and modified ACD frailty index, follow-up univariate 1-way ANCOVA was performed to assess postoperative outcomes. Logistic regressions assessed the impact of committee review on prediction of complications or reoperation.

Results: Of 149 ACD patients (mean ± SD age 57.5 ± 10.9 years, 58.2% female, BMI 28.5 ± 7.8 kg/m2), 51.0% (n = 76) underwent committee review. At baseline, cohorts were comparable in terms of age, sex, and BMI, although patients undergoing HRR (HRR+) were frailer according to the modified ACD frailty index (p < 0.001). HRR+ patients were also significantly more likely to have a history of myocardial infarction (p = 0.045). Radiographically, HRR+ patients were more likely to have more severe deformity in terms of T1 slope minus cervical lordosis (p = 0.031) and C2-7 sagittal vertical axis (p < 0.001) compared to patients who did not undergo high-risk review (HRR-). Perioperatively, HRR- patients had significantly greater mean operative time (p < 0.001) and were more likely to undergo any osteotomy (p = 0.020) or 3-column osteotomy (p = 0.045), although total estimated blood loss, length of stay, surgical intensive care unit admissions, and discharge dispositions were comparable between groups (all p > 0.05). Rates of any complications and mortality were also comparable between groups (all p > 0.05). HRR+ patients demonstrated lower reoperation rates (p = 0.037). Yet, adjusted regression revealed that HRR was neither independently predictive of intraoperative major complications nor reoperation (all p > 0.05).

Conclusions: Implementation of high-risk committees is associated with a lower frequency of high-risk procedures over time. However, the risk of complications is not necessarily diminished after the establishment of such committees.