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Do Publicly Available Risk Calculators Apply to Adult Spinal Deformity Surgery?
Anthony Pajak1,2, Justin T Samuel1, Tejas Subramanian1,3
1Department of Spine Surgery, Hospital for Special Surgery, 535 E. 71st Street, New York, NY 10021, USA.
Journal of Clinical Medicine
|December 30, 2025
Summary
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and SpineSage risk calculators show strong calibration but poor discrimination for predicting complications after adult spinal deformity surgery. Further refinement is needed for accurate risk prediction in these complex cases.
Area of Science:
- Spine Surgery
- Surgical Quality Improvement
- Predictive Analytics
Background:
- Automated risk calculators, including ACS-NSQIP and SpineSage, aim to predict surgical complications.
- Assessing the validity of these tools for adult spinal deformity (ASD) surgery is crucial for patient care and surgical planning.
Purpose of the Study:
- To evaluate the predictive accuracy of the ACS-NSQIP and SpineSage risk calculators for short-term complications following ASD surgery.
- To assess the calibration and discrimination capabilities of these risk calculators in a cohort of ASD patients.
Main Methods:
- Retrospective analysis of 198 adult spinal deformity patients undergoing posterior spinal fusion (2017-2020).
- Patient data was input into ACS-NSQIP and SpineSage calculators to predict 30-day outcomes.
- Calibration assessed via Brier scores; discrimination assessed via C-statistics.
Main Results:
- ACS-NSQIP demonstrated strong calibration for most complications but poor discrimination, except for surgical site infection, VTE, and readmission.
- SpineSage showed strong calibration for most complications but poor discrimination across all assessed outcomes.
- Neither calculator accurately predicted all short-term complications in the ASD surgery cohort.
Conclusions:
- Both ACS-NSQIP and SpineSage risk calculators exhibit limitations in predicting short-term complications after ASD surgery.
- ACS-NSQIP's potential deficits may stem from CPT code reliance; SpineSage's may arise from including common perioperative events.
- Further development is required to enhance the discriminatory power of these tools for complex spinal procedures.
