<p>Mortality risk factors associated with three-column osteotomies for adult spinal deformity, as presented by Carbone et al. provides valuable insights. This multi-institutional study uses the National Surgical Quality Improvement Program database to identify critical mortality risk factors. However, there are a few points that need to be addressed. Reliance on CPT codes, absence of long-term follow-up, and insufficient adjustment for key confounders, such as functional status and intraoperative restricts depth of the analysis. The study’s oversimplified frailty assessment and lack of subgroup analysis further limit its clinical applicability. Moreover, the omission of a detailed exploration of complications and their association with mortality, including “failure to rescue” and non-home discharge rates, represents missed opportunities for actionable insights.</p>