Predictive Analytics for Determining Extended Operative Time in Corrective Adult Spinal Deformity Surgery.

Area of Science:

• Spine surgery
• Surgical outcomes
• Health services research

Background:

• Advanced surgical techniques for adult spinal deformity (ASD) increase operative times, leading to greater patient stress and complications.
• Identifying factors influencing operative time is crucial for optimizing surgical planning and patient safety.

Purpose of the Study:

• To determine the key factors associated with operative time in adult spinal deformity (ASD) surgery using statistical learning.
• To analyze the impact of surgeon, institution, surgical approach, and patient-specific factors on surgical duration.

Main Methods:

• Retrospective review of a prospective multicenter database of 837 patients undergoing long spinal fusions for ASD.
• Conditional inference decision trees were employed to identify significant predictors and cutoff points for operative time.
• Variable importance was assessed using 2000 conditional inference trees, with means comparison for effect sizes.

Main Results:

• Institution/surgeon was the strongest predictor of operative time, with significant differences between centers (up to 2 hours difference).
• Other key predictors included surgical approach (combined vs. posterior), number of spinal levels fused, patient age, and frailty score.
• Surgical techniques like osteotomies, interbody device placement, and decompression also increased operative time. Extended operative time correlated with increased length of stay, blood loss, and poorer 2-year ODI scores.

Conclusions:

• Procedure location and surgeon expertise are the most significant determinants of operative time in ASD surgery.
• Surgical approach and fusion length are also associated with longer operative times.
• Extended operative times are linked to adverse outcomes, including longer hospital stays, increased blood loss, and diminished functional recovery.