Grading of Complications After Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable?
Clin Spine Surg
STUDY DESIGN: This is a retrospective review of prospective multicenter cervical deformity (CD) database.
OBJECTIVE: Assess the impact of complication type and Clavien complication (Cc) grade on clinical outcomes of surgical CD patients BACKGROUND:: Validated for general surgery, the Clavien-Dindo complication classification system allows for broad comparison of postoperative complications; however, the applicability of this system is unclear in CD-specific populations.
METHODS: Surgical CD patients above 18 years with baseline and postoperative clinical data were included. Primary outcomes were complication type (renal, infection, cardiac, pulmonary, gastrointestinal, neurological, musculoskeletal, implant-related, radiographic, operative, wound) and Cc grade (I, II, III, IV, V). Secondary outcomes were estimated blood loss (EBL), length of stay (LOS), reoperation, and health-related quality of life (HRQL) score. The univariate analysis assessed the impact of complication type and Cc grade on improvement markers and 1-year postoperative HRQL outcomes.
RESULTS: In total, 153 patients (61±10 y, 61% female) underwent surgery for CD (8.1±4.6 levels fused; surgical approach included 48% posterior, 18% anterior, 34% combined). Overall, 63% of patients suffered at least 1 complication. Complication breakdown by type: renal (2.0%), infection (5.2%), cardiac (7.2%), pulmonary (3.9%), gastrointestinal (2.0%), neurological (26.1%), musculoskeletal (0.0%), implant-related (3.9%), radiographic (16.3%), operative (7.8%), and wound (5.2%). Of complication types, only operative complications were associated with increased EBL (P=0.004), whereas renal, cardiac, pulmonary, gastrointestinal, neurological, radiographic, and wound infections were associated with increased LOS (P0.05).
CONCLUSIONS: Increasing complication severity, assessed by the Clavien-Dindo classification system, was not associated with increased EBL, inpatient LOS, or inferior 1-year postoperative HRQL outcomes. Only operative complications were associated with increased EBL. These results suggest a need for modification of the Clavien system to increase applicability and utility in CD-specific populations.
Neurosciences (Brain & Spine)
Orthopedics & Sports Medicine
Bortz, Cole A; Passias, Peter G; Segreto, Frank A; Horn, Samantha R; Lafage, Renaud; Smith, Justin S; Line, Breton G; Mundis, Gregory M; Kelly, Michael P; Park, Paul; Sciubba, Daniel M; Hamilton, D Kojo; Gum, Jeffrey L; Burton, Douglas C; Hart, Robert A; Schwab, Frank J; Bess, Shay; Shaffrey, Christopher; and Klineberg, Eric O, "Grading of Complications After Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable?" (2018). Articles, Abstracts, and Reports. 967.