Patient-Specific Risk Adjustment Improves Comparison of Infection Rates Following Posterior Fusion for Adolescent Idiopathic Scoliosis

The Journal of Bone and Joint Surgery. American Volume
Peter O NewtonBurt Yaszay

Abstract

There is increasing interest in surgeon "performance measures." Understanding patient factors that increase the risk of adverse events is important for the comparison of such metrics among surgeons and centers. The purpose of this study was to ascertain whether patient characteristics, beyond the control of the surgeon, were associated with increased risk of postoperative infection following posterior spinal fusion for the correction of adolescent idiopathic scoliosis (AIS) and to establish a "risk-adjusted" method of reporting postoperative infection rates. We reviewed the data of patients from 14 participating scoliosis treatment centers who experienced an infection within 90 days following posterior spinal fusion for the treatment of AIS. Patients with a deep infection (irrigation and debridement performed) were compared with those without an infection with regard to age, sex, body mass index (BMI) percentile for age, Lenke classification of curve type, primary curve magnitude, and estimated 3-dimensional sagittal kyphosis (T5-T12). A regression model was created to identify variables that were associated with infection, and the performance of the risk model was evaluated. The actual infection rate by site was divided by the...Continue Reading

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