Impact of High-Risk Committees in Cervical Deformity Surgery: A Retrospective Review Of Outcomes, Complications, And Frequency of Procedures Receiving Pre-Operative Multidisciplinary Evaluation

Introduction: To prevent or minimize the occurrence of complications, some institutions have implemented pre-operative multidisciplinary committees tasked with reviewing the safety and utility of such procedures. However, the utility of such committees remains understudied.

Methods: CD patients ≥18yrs with pre-(BL) and 2-year(2Y) data were stratified as necessitating high-risk review or not (HRR+ vs HRR-). HHR were defined as any of: 1) A-P CD fusion ≥3 levels, 2) planned 3-column osteotomy, VCR, and/or ACR 3) deformity correction with severe BL neurological deficit 4) severe BL myelopathy (mJOA < 11), 5) severe osteoporosis with fusion ≥4 levels. Differences in baseline factors were assessed via means comparison. Adjusting for BL age and mACD-FI, ANCOVAs assessed post-operative outcomes. Logistic regressions adjusting for BL age, mACD-FI, DOS, and BL TS-CL and cSVA assessed impact of committee review on prediction of complications or reoperation. Linear regression assessed frequency of HR procedures by DOS.

Results: Of 149 CD patients (57.5±10.9 yrs, 58.2% F, 28.5±7.8 kg/m2), and 51.0% underwent committee review. At baseline, HR+ patients were more frail per mACD-FI (p <.001). HRR+ patients had higher operative time (p <.001) and were more likely to undergo osteotomy (p=.020) or 3CO (p=.045). Mortality was comparable between groups (all p>.05), though HRR+ were more likely to experience peri-op cardiopulmonary complications (p=.033). DJK rates by 2Y were also higher in HR+ patients. However, HRR- patients reported higher reoperation rates (p=.037). Yet, adjusted regression revealed that HRR was not independently predictive of major complications, nor reoperation (all p>.05). Backstep linear regression accounting for BL age and gender found a significant negative correlation between increasing date of surgery and frequency of HR cases (model p=.009).

Conclusion : Implementation of high-risk committee is associated with a lower frequency of high-risk procedures over time. Despite these findings, increased peri-operative cardiopulmonary complications in high-risk patients suggests that the risk of adverse events is not necessarily dimished after establishment of such committees.