Assessing the Impact of High-risk Committees in Adult Cervical Deformity Corrective Surgery: Outcomes, Complications, and Frequency of Procedures Receiving Preoperative Multidiscplinary Evaluation

Introduction: Some institutions have implemented preoperative multidisciplinary committees tasked to review the safety and utility of procedures to prevent/minimize the occurrence of complications.

Methods: Operative CD patients≥18yrs with complete BL and 2Y radiographic/HRQL data stratified as necessitating high-risk review by senior spine surgeon and anaesthesiologists versus not(HRR+ vs HRR-). HRR+ patients defined by meeting any of the following: anterior-posterior CD fusion ≥3 levels, planned 3-column osteotomy, VCR, and/or ACR, deformity correction with severe BL neurological deficit, severe BL myelopathy(mJOA < 11), severe osteoporosis with fusion ≥4 levels. Group differences assessed via means comparison. Adjusting for BL age and mACD-FI, follow-up univariate one-way ANCOVAs assessed postoperative outcomes. Logistic regressions adjusting for BL age, mACD-FI, and date of surgery, and BL TS-CL and cSVA assessed impact of committee review on prediction of complications /reoperation. Non-parametric Mann-Whitney U Test assessed distribution of HR procedures by DOS.

Results: Of 149 CD patients(57.5±10.9years, 58.2%female, 28.5±7.8kg/m2), 51.0%(n=76) underwent committee review. At baseline, cohorts were comparable in age, gender, and BMI. HR+ more frail per mACD-FI(p <.001). HRR+ also significantly more likely to have a history of MI(p=.045). HRR+ were more likely to have more severe deformity per TS-CL(p=.031) and C2-C7 SVA(p <.001). HRR+ patients had significantly higher mean operative time(p <.001), and were more likely to undergo any osteotomy(p=.020) or 3CO(p=.045). Total EBL, LOS, SICU admissions, and discharge dispositions were comparable between groups(all p>.05). Rates of any complications and mortality were also comparable between groups(all p>.05). HRR+ were significantly more likely to experience perioperative cardiopulmonary complications(p=.033). HRR- patients reported significantly higher reoperation rates(p=.037). Adjusted regression revealed that HRR was not independently predictive of intraoperative major complications/reoperation(all p>.05). Backstep linear regression accounting for BL age and gender found a significant negative correlation between increasing DOS and frequency of HR cases(model p=.009).

Conclusion : The present study reveals that implementing high-risk committees is associated with a lower frequency of high-risk procedures over time. Despite these findings, increased peri-operative cardiopulmonary complications in high-risk patients suggest that the risk of adverse events does not necessarily diminish.