Complication Events After Spinal Surgery Performed by American Board of Orthopaedic Surgery (ABOS) Part II Candidates (2008–2017)
Bibliographic record
Abstract
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate complications following spine surgery using American Board of Orthopaedic Surgeons (ABOS) Part II examination data from 2008 to 2017. SUMMARY OF BACKGROUND DATA: Recent research has demonstrated the importance of surgical experience and clinical volume in minimizing complications after spine surgery. This may be challenging for orthopedic spine surgeons who are just starting their practice. METHODS: We performed a retrospective review of surgical cases submitted to the ABOS by candidates taking the Part II Spine examination between 2008 and 2017. Complications, including peri-operative mortality as reported by candidates to the ABOS, were tracked over time. Complications were classified as surgical or medical using a predefined algorithm. Multivariable Poisson regression analyses adjusting for confounders were used to assess rates of complications and mortality over time. All analyses controlled for biologic sex, age, surgical diagnosis, and surgical location. RESULTS: A total of 37,539 spine surgical patients were analyzed, with an average of 3754 cases performed each year. Following adjusted Poisson analysis, we determined that cases in 2017 had an increased likelihood of complications when compared to those treated in 2008 (IRR 1.20; 95% CI 1.09, 1.32). Similar findings were encountered for surgical complications (IRR 1.20; 95% CI 1.07, 1.34). In contrast, spine surgical cases reported to the ABOS in 2017 had a 55% lower likelihood of mortality when compared to procedures performed in 2008 (IRR 0.45; 95% CI 0.24, 0.84; P = 0.01). CONCLUSIONS: Our analysis of ABOS Part II candidates demonstrates that reported complication rates may be increasing while mortality is decreasing. The etiologies behind these findings are likely multifactorial. Encouragingly, we believe that observed reductions in mortality suggest overall improvements in patient safety following spine surgery. At a minimum, our data provide benchmarks through which spine surgeons, hospitals, and residency or fellowship programs can evaluate performance.Level of Evidence: 4.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".