Grading of Complications After Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable?. Issue 6 (July 2019)

• Record Type: Journal Article
• Authors: 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; Klineberg, Eric O.
• Is Part Of: Clinical spine surgery. Volume 32:Issue 6(2019)
• Publication Date: 2019-07
• Subjects: cervical deformity -- complications -- Clavien -- Clavien-Dindo -- classification; Spinal cord -- Diseases -- Periodicals; Spinal cord -- Surgery -- Periodicals; 617.56059
• DOI: 10.1097/BSD.0000000000000748
• Languages: English
• ISSNs: 2380-0186

Abstract

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.