Perioperative Medical Complications in Adult Spine Deformity Surgery: Classification and Prevention Strategies

Study DesignNarrative review.ObjectiveWe aimed to propose the classifications of, risk factors for, and prevention strategies for perioperative complications from previously published papers in adult spinal deformity (ASD) surgeries.MethodsA literature search was conducted in the PubMed/MEDLINE database to identify studies reporting perioperative complications of spinal deformity surgery, their classifications, risk factors, and prevention strategies. Main search terms included "perioperative complications", "medical complications" and "adult spinal deformity". In the various complications associated with deformity surgeries, we focused the medical complications which will directly link to patient's life prognosis rather than postoperative mechanical complications.ResultsThe overall perioperative complication rate ranged from 12.8% to 52.2%. Risk factors for perioperative medical complications included age, body mass index, osteoporosis, frailty, comorbidities, preoperative medication, smoking habit, and alcohol intake. Perioperative medical complications mostly depend on patient-related factors. Taking reference from the previous reported classification of surgical complications, the AO Spine Deformity Knowledge Forum developed a classification for complications of spinal deformity surgery via a Delphi exercise.ConclusionComplication classification system is important for understanding the impact of complications on patients. Further research should aim to determine the correlation between the new complication classification and patient outcomes in spinal deformity surgery. Various pre-, intra-, and postoperative strategies should be implemented to prevent perioperative complications.