March 2016

Risk Stratification Task Force Update

Steven D. Glassman, MD
Directed Research Task Force Chair

What is Risk Stratification?

Risk stratification is the use of evidence to assist in predicting unfavorable outcome and complications.  In essence, it is an effort to quantify the evaluation process that surgeon’s undertake every time they look at a patient and recommend surgical treatment. Where risk stratification has been done most effectively, whether in healthcare or elsewhere, the common thread is adequate reliable data.  As an example, the American College of Surgeons (ACS) has built an online risk calculator through the NSQIP database, which includes granular data on over a million patients. 

Why should the SRS pursue Risk Stratification?

Spinal deformity surgery is complex and often represents a high risk/high reward proposition.  Despite our perception that spine deformity surgery is unique in terms of both patient characteristics and surgical intensity, there is limited data validating which exact aspects drive risk.  Quantifying predictors of complications and outcomes may facilitate better surgical decision making.  This may also help level the playing field as surgeons are graded based upon surgical outcomes or complications.  Certainly, one could not expect equivalent results in the treatment of neuromuscular scoliosis versus adolescent idiopathic scoliosis or young adults with coronal deformities compared to elderly patients with substantial sagittal plane deformity.

How is the SRS supporting this effort?

The SRS recognizes the importance of risk stratification from both a patient care and an access to care standpoint.  Our goal is firstly to educate the membership regarding the rationale, methodology and impact of risk stratification efforts.  At the same time, the SRS is actively supporting a broad research strategy examining risk stratification for spinal deformity.  One element is a SRS directed project building a modified consensus model to identify critical components for subsequent risk stratification processes.  In addition, the SRS has provided the Research Grant Committee with $150,000 additional funding for meritorious submissions related to the overall risk stratification research effort.  We strongly encourage SRS members with research interests in the area of risk stratification to pursue this funding opportunity.