Purpose 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. Methods 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. Results 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). Conclusion 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.

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

期刊论文
发表日期：

2026年1月25日

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Omar Sbaih,
Rohin Singh,
Aman Singh,
Nithin Gupta,
Adam Li,
Shane Shahrestani,
Jonathan J. Stone

摘要

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.