Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery

Brian J. Neuman, MD; Andrew B. Harris, BS; Eric O. Klineberg, MD; Richard A. Hostin, MD; Themistocles S. Protopsaltis, MD; Peter G. Passias, MD; Jeffrey L. Gum, MD; Robert A. Hart, MD; Michael P. Kelly, MD; Alan H. Daniels, MD; Christopher P. Ames, MD; Christopher I. Shaffrey, MD; Khaled M. Kebaish, MD


Spine. 2021;46(14):931-938. 

In This Article


ASD patients who underwent surgical procedures with ASD-SR invasiveness scores of ≥90 had greater odds of experiencing major complications, whereas their odds of minor complications (except for incidental durotomy) were not greater above this threshold. By ASD-SR score quartiles, the largest increase in complications was when ASD-SR score increased from below 90 to ≥90. These results improve the utility of the ASD-SR invasiveness index when counseling patients during the perioperative period and provide a better understanding of the complex relationship between surgical invasiveness and complication risk.