{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:05:46Z","timestamp":1784955946740,"version":"3.55.0"},"reference-count":28,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The International Spine Study Group-AO (ISSG-AO) Adult Spinal Deformity (ASD) Complication Classification System was developed to improve classification, reporting, and study of complications among patients undergoing ASD surgery. The ISSG-AO system classifies interventions to address complications by level of invasiveness: grade zero (none); grade 1, mild (e.g., medication change); grade 2, moderate (e.g., ICU admission); grade 3, severe (e.g., reoperation related to surgery of interest). To evaluate the efficacy of the ISSG-AO ASD Complication Classification System, we aimed to compare correlations between postoperative length of stay (LOS) and complication severity as classified by the ISSG-AO ASD and traditional major\/minor complication classification systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients age \u226518 in a multicenter ASD database who sustained in-hospital complications were identified. Complications were classified with the major\/minor and ISSG-AO systems and correlated with LOS using an ensemble-based machine learning algorithm (conditional random forest) and a generalized linear mixed model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>490 patients at 19 sites were included. 64.9% of complications were major, and 35.1% were minor. By ISSG-AO classification, 20.4%, 66.1%, 6.7%, and 6.7% were grades 0-3, respectively. ISSG-AO complication grading demonstrated significant correlation with LOS, whereas major\/minor complication classification demonstrated inverse correlation with LOS. In conditional random forest analysis, ISSG-AO classification had the greatest relative importance when assessing correlations across multiple variables with LOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The ISSG-AO system may help identify specific complications associated with prolonged LOS. Targeted interventions to avoid or reduce these complications may improve ASD surgical quality and resource utilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682231202782","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T18:03:16Z","timestamp":1695146596000},"page":"621-632","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["The ISSG-AO Complication Intervention Score, but Not Major\/Minor Designation, is Correlated With Length of Stay Following Adult Spinal Deformity Surgery"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0030-0367","authenticated-orcid":false,"given":"Joseph B.","family":"Wick","sequence":"first","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0672-9594","authenticated-orcid":false,"given":"Andrew","family":"Blandino","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"University of Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0395-1066","authenticated-orcid":false,"given":"Breton G.","family":"Line","sequence":"additional","affiliation":[{"name":"Denver International Spine Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-7111","authenticated-orcid":false,"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Lenox Hill Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4820-1835","authenticated-orcid":false,"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"NYU Hospital for Joint Diseases"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0471-9437","authenticated-orcid":false,"given":"Jeffrey L.","family":"Gum","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled M.","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert K.","family":"Eastlack","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Daniels","sequence":"additional","affiliation":[{"name":"Brown University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Mundis","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"Baylor Scoliosis Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"NYU Hospital for Joint Diseases"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Rady Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4711-4377","authenticated-orcid":false,"given":"Munish","family":"Gupta","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Hart","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Schwab","sequence":"additional","affiliation":[{"name":"Lenox Hill Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C.","family":"Burton","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Columbia University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Duke University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Denver International Spine Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"University of Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"International Spine Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,9,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000160842.43482.cd"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181e9f120"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001202"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001338"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/2017.3.SPINE161011"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181e21783"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.3171\/2011.7.SPINE10640"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31814cf24a"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-018-5790-y"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31815a7644"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199606000-00006"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003766"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003520"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.06.155"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.3.SPINE181180"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.3171\/2018.8.SPINE18594"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.3171\/2018.8.SPINE181024"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.11.125"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682211004250"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004122"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/2192568220937473"},{"issue":"5","key":"e_1_3_3_23_2","first-page":"518","article-title":"Proposed classification of complications of surgery with examples of utility in cholecystectomy","volume":"111","author":"Clavien PA","year":"1992","unstructured":"Clavien PA, Sanabria JR, Strasberg SM. 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