GAP score potential in predicting post-operative spinal mechanical complications: a systematic review of the literature,European Spine Journal

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GAP score potential in predicting post-operative spinal mechanical complications: a systematic review of the literature
European Spine Journal ( IF 2.6 ) Pub Date : 2022-09-25 , DOI: 10.1007/s00586-022-07386-6
E Quarto ₁ , A Zanirato ₁ , M Pellegrini ₁ , S Vaggi ₁ , F Vitali ₁ , S Bourret ₂ , J C Le Huec ₂ , M Formica ₁

Affiliation

Purpose

In 2017, the GAP score was proposed as a tool to reduce mechanical complications (MC) in adult spinal deformity (ASD) surgery: the reported MC rate for the GAP proportioned category was only 6%, which is clearly lower to the MC rate reported in the literature. The aim of this study is to analyse if the most recent literature confirms the promising results of the original article.

Materials and methods

Using the PRISMA flow chart, we reviewed the literature to analyse GAP score capacity in predicting MC occurrence. We included articles clearly reporting ASD surgery MC stratified by GAP categories and the score’s overall capacity to predict MC using the area under the curve (AUC). The quality of the included studies was evaluated using GRADE and MINORS systems.

Results

Eleven retrospective articles (1,517 patients in total) were included. The MC distribution per GAP category was as follows: GAP-P, 32.8%; GAP-MD, 42.3%; GAP-SD, 55.4%. No statistically significant difference was observed between the different categories using the Kruskal–Wallis test (p = 0.08) and the two-by-two Pearson-Chi square test (P Vs MD, p = 0.300; P Vs SD, p = 0.275; MD Vs SD, p = 0.137). The global AUC was 0.68 ± 0.2 (moderate accuracy). The included studies were of poor quality according to the GRADE system and had a high risk of bias based on the MINORS criteria.

Conclusion

The actual literature does not corroborate the excellent results reported by the original GAP score article. Further prospective studies, possibly stratified by type of MC and type of surgery, are necessary to validate this score.

中文翻译：

GAP 评分在预测术后脊柱机械并发症中的潜力：文献的系统回顾

目的

2017年，GAP评分被提出作为减少成人脊柱畸形（ASD）手术中机械并发症（MC）的工具：报告的GAP比例类别的MC率仅为6%，明显低于报告的MC率在文献中。本研究的目的是分析最新文献是否证实了原始文章的有希望的结果。

材料和方法

使用 PRISMA 流程图，我们回顾了文献来分析 GAP 评分在预测 MC 发生方面的能力。我们纳入的文章清楚地报告了按 GAP 类别分层的 ASD 手术 MC，以及使用曲线下面积 (AUC) 预测 MC 的评分总体能力。使用 GRADE 和 MINORS 系统评估纳入研究的质量。

结果

纳入 11 篇回顾性文章（总共 1,517 名患者）。每个 GAP 类别的 MC 分布如下：GAP-P，32.8%； GAP-MD，42.3%； GAP-SD，55.4%。使用 Kruskal-Wallis 检验 ( p = 0.08) 和二乘二 Pearson-Chi 方检验（P Vs MD， p = 0.300；P Vs SD，p = 0.275；P Vs SD， p = 0.275；P Vs MD，p = 0.300； MD 与 SD， p = 0.137）。总体 AUC 为 0.68 ± 0.2（中等准确度）。根据 GRADE 系统，纳入的研究质量较差，并且根据 MINORS 标准，存在较高的偏倚风险。