Cole A Bortz1, Peter G Passias1, Frank A Segreto1, Samantha R Horn1, Renaud Lafage2, Justin S Smith3, Breton G Line4, Gregory M Mundis5, Michael P Kelly6, Paul Park7, Daniel M Sciubba8, D Kojo Hamilton9, Jeffrey L Gum10, Douglas C Burton11, Robert A Hart12, Frank J Schwab2, Shay Bess13, Christopher Shaffrey3, Eric O Klineberg14. 1. Department of Orthopedics, NYU Langone Orthopedic Hospital. 2. Department of Orthopedics, Hospital for Special Surgery, New York, NY. 3. Department of Neurosurgery, University of Virginia, Charlottesville, VA. 4. Denver, CO. 5. San Diego Center for Spinal Disorders, La Jolla, CA. 6. Department of Orthopaedic Surgery, Washington University, St. Louis, MO. 7. Department of Neurologic Surgery, University of Michigan, Ann Arbor, MI. 8. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. 9. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. 10. Norton Leatherman Spine Center, Louisville, KY. 11. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS. 12. Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA. 13. Rocky Mountain Scoliosis and Spine, Denver, CO. 14. Department of Orthopaedic Surgery, University of California, Davis, Davis, CA.
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.
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 CDpatients 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 CDpatients 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.
Authors: Han Jo Kim; Yu-Cheng Yao; Christopher I Shaffrey; Justin S Smith; Michael P Kelly; Munish Gupta; Todd J Albert; Themistocles S Protopsaltis; Gregory M Mundis; Peter Passias; Eric Klineberg; Shay Bess; Virginie Lafage; Christopher P Ames Journal: Global Spine J Date: 2020-11-23
Authors: Peter Gust Passias; Avery E Brown; Haddy Alas; Katherine E Pierce; Cole A Bortz; Bassel Diebo; Renaud Lafage; Virginie Lafage; Douglas C Burton; Robert Hart; Han Jo Kim; Shay Bess; Kevin Moattari; Rachel Joujon-Roche; Oscar Krol; Tyler Williamson; Peter Tretiakov; Bailey Imbo; Themistocles S Protopsaltis; Christopher Shaffrey; Frank Schwab; Robert Eastlack; Breton Line; Eric Klineberg; Justin Smith; Christopher Ames Journal: J Craniovertebr Junction Spine Date: 2021-12-11