Dynamic modeling of 30-day mortality following adult spinal deformity surgery: insights from the ACS-NSQIP database

Surgical treatment for ASD is complex and associated with significant perioperative risks. Despite advancements in surgical techniques and perioperative care, complications remain common. This study aims to develop a predictive model of 30-day mortality in patients undergoing surgery for ASD using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2014 to 2022.

Patients included were aged ≥ 18 years undergoing ASD surgeries were included. Major complications were defined as deep surgical site infection (SSI), organ space SSI, wound dehiscence, prolonged ventilation ≥ 48 h, pulmonary embolism, cerebrovascular accident, renal failure, myocardial infarction, cardiac arrest, bleeding requiring transfusion, sepsis, septic shock, pneumonia, and unplanned reintubation. The primary outcome of interest was 30-day mortality. Categorical variables were analyzed using the Pearson χ² test, and continuous variables were analyzed using the Mann-Whitney U test.

The study cohort included 2471 adults. The overall mortality rate within 30 days of 0.5% (13/2471). Patients who experienced mortality were significantly more likely to present with COPD (30.8% vs. 3.5%, p < 0.001), chronic heart failure (CHF; 23.1% vs. 0.9%, p < 0.001), and chronic steroid use (23.1% vs. 4.6%, p = 0.031). The median hospital stay was twice as long in the mortality group (12 vs. 6 days). Independent predictors of mortality included COPD (OR: 7.48; 95% CI: 1.06-52.95; p = 0.044), CHF (OR: 32.73; 95% CI: 3.11-344.81; p = 0.004), chronic steroid use (OR: 11.42; 95% CI: 1.58-82.60; p = 0.016), unplanned intubation (OR: 58.66; 95% CI: 10.66-322.86; p < 0.001), septic shock (OR: 15.41; 95% CI: 1.51-157.56; p = 0.021), and renal insufficiency (OR: 32.55; 95% CI: 3.57-296.84; p = 0.002). The model demonstrated excellent predictive performance for mortality, with an area under the ROC curve (AUC) of 0.987 (95% CI: 0.961-0.999).

Our analysis of 2471 patients from the ACS-NSQIP database highlights the significant role of key preoperative and postoperative factors, such as COPD, CHF, and septic shock, in predicting 30-day mortality. These findings emphasize the importance of integrating these predictors into preoperative assessments and decision-making processes to better stratify risk and guide personalized interventions.