Grading of Complications After Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable?
| dc.contributor.author | Bortz, Cole A | |
| dc.contributor.author | Passias, Peter G | |
| dc.contributor.author | Segreto, Frank A | |
| dc.contributor.author | Horn, Samantha R | |
| dc.contributor.author | Lafage, Renaud | |
| dc.contributor.author | Smith, Justin S | |
| dc.contributor.author | Line, Breton G | |
| dc.contributor.author | Mundis, Gregory M | |
| dc.contributor.author | Kelly, Michael P | |
| dc.contributor.author | Park, Paul | |
| dc.contributor.author | Sciubba, Daniel M | |
| dc.contributor.author | Hamilton, D Kojo | |
| dc.contributor.author | Gum, Jeffrey L | |
| dc.contributor.author | Burton, Douglas C | |
| dc.contributor.author | Hart, Robert A | |
| dc.contributor.author | Schwab, Frank J | |
| dc.contributor.author | Bess, Shay | |
| dc.contributor.author | Shaffrey, Christopher | |
| dc.contributor.author | Klineberg, Eric O | |
| dc.contributor.author | International Spine Study Group | |
| dc.date.accessioned | 2023-06-20T13:11:52Z | |
| dc.date.available | 2023-06-20T13:11:52Z | |
| dc.date.issued | 2019-07 | |
| dc.date.updated | 2023-06-20T13:11:51Z | |
| dc.description.abstract | Study designThis is a retrospective review of prospective multicenter cervical deformity (CD) database.ObjectiveAssess 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.MethodsSurgical 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.ResultsIn 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).ConclusionsIncreasing 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. | |
| dc.identifier.issn | 2380-0186 | |
| dc.identifier.issn | 2380-0194 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Ovid Technologies (Wolters Kluwer Health) | |
| dc.relation.ispartof | Clinical spine surgery | |
| dc.relation.isversionof | 10.1097/bsd.0000000000000748 | |
| dc.subject | International Spine Study Group | |
| dc.subject | Cervical Vertebrae | |
| dc.subject | Humans | |
| dc.subject | Postoperative Complications | |
| dc.subject | Treatment Outcome | |
| dc.subject | Length of Stay | |
| dc.subject | Reoperation | |
| dc.subject | Quality of Life | |
| dc.subject | Adult | |
| dc.subject | Female | |
| dc.subject | Male | |
| dc.title | Grading of Complications After Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable? | |
| dc.type | Journal article | |
| duke.contributor.orcid | Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226 | |
| duke.contributor.orcid | Shaffrey, Christopher|0000-0001-9760-8386 | |
| pubs.begin-page | 263 | |
| pubs.end-page | 268 | |
| pubs.issue | 6 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Orthopaedic Surgery | |
| pubs.organisational-group | Neurosurgery | |
| pubs.publication-status | Published | |
| pubs.volume | 32 |
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