Grading of Complications after Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable?

International Spine Study Group

Research output: Contribution to journalArticle

Abstract

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 (P<0.050). Patients were also assessed by Cc grade: I (28%), II (14.3%), III (16.3%), IV (6.5%), and V (0.7%). Grades I and V were associated with increased EBL (both P<0.050); Cc grade V was the only complication not associated with increased LOS (P=0.610). Increasing complication severity was correlated with increased risk of reoperation (r=0.512; P<0.001), but not inferior 1-year HRQL outcomes (all P>0.05). 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.

Original languageEnglish (US)
JournalClinical Spine Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Length of Stay
Quality of Life
Kidney
Lung
Wounds and Injuries
Wound Infection
Infection
Reoperation
Population
Inpatients
Databases

Keywords

  • cervical deformity
  • classification
  • Clavien
  • Clavien-Dindo
  • complications

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Grading of Complications after Cervical Deformity-corrective Surgery : Are Existing Classification Systems Applicable? / International Spine Study Group.

In: Clinical Spine Surgery, 01.01.2018.

Research output: Contribution to journalArticle

@article{600119c9721240f896ea3b41ea8bf691,
title = "Grading of Complications after Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable?",
abstract = "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 (P<0.050). Patients were also assessed by Cc grade: I (28{\%}), II (14.3{\%}), III (16.3{\%}), IV (6.5{\%}), and V (0.7{\%}). Grades I and V were associated with increased EBL (both P<0.050); Cc grade V was the only complication not associated with increased LOS (P=0.610). Increasing complication severity was correlated with increased risk of reoperation (r=0.512; P<0.001), but not inferior 1-year HRQL outcomes (all P>0.05). 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.",
keywords = "cervical deformity, classification, Clavien, Clavien-Dindo, complications",
author = "{International Spine Study Group} and Bortz, {Cole A.} and Passias, {Peter G.} and Segreto, {Frank A.} and Horn, {Samantha R.} and Renaud Lafage and Smith, {Justin S.} and Line, {Breton G.} and Mundis, {Gregory M.} and Kelly, {Michael P.} and Paul Park and Sciubba, {Daniel M.} and Hamilton, {D. Kojo} and Gum, {Jeffrey L.} and Burton, {Douglas C.} and Hart, {Robert A.} and Schwab, {Frank J.} and Shay Bess and Christopher Shaffrey and Klineberg, {Eric Otto}",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/BSD.0000000000000748",
language = "English (US)",
journal = "Clinical Spine Surgery",
issn = "2380-0186",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Grading of Complications after Cervical Deformity-corrective Surgery

T2 - Are Existing Classification Systems Applicable?

AU - International Spine Study Group

AU - Bortz, Cole A.

AU - Passias, Peter G.

AU - Segreto, Frank A.

AU - Horn, Samantha R.

AU - Lafage, Renaud

AU - Smith, Justin S.

AU - Line, Breton G.

AU - Mundis, Gregory M.

AU - Kelly, Michael P.

AU - Park, Paul

AU - Sciubba, Daniel M.

AU - Hamilton, D. Kojo

AU - Gum, Jeffrey L.

AU - Burton, Douglas C.

AU - Hart, Robert A.

AU - Schwab, Frank J.

AU - Bess, Shay

AU - Shaffrey, Christopher

AU - Klineberg, Eric Otto

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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 (P<0.050). Patients were also assessed by Cc grade: I (28%), II (14.3%), III (16.3%), IV (6.5%), and V (0.7%). Grades I and V were associated with increased EBL (both P<0.050); Cc grade V was the only complication not associated with increased LOS (P=0.610). Increasing complication severity was correlated with increased risk of reoperation (r=0.512; P<0.001), but not inferior 1-year HRQL outcomes (all P>0.05). 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.

AB - 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 (P<0.050). Patients were also assessed by Cc grade: I (28%), II (14.3%), III (16.3%), IV (6.5%), and V (0.7%). Grades I and V were associated with increased EBL (both P<0.050); Cc grade V was the only complication not associated with increased LOS (P=0.610). Increasing complication severity was correlated with increased risk of reoperation (r=0.512; P<0.001), but not inferior 1-year HRQL outcomes (all P>0.05). 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.

KW - cervical deformity

KW - classification

KW - Clavien

KW - Clavien-Dindo

KW - complications

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