Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes

Eric O. Klineberg, Peter G. Passias, Gregory W. Poorman, Cyrus M. Jalai, Abiola Atanda, Nancy Worley, Samantha Horn, Daniel M. Sciubba, D. Kojo Hamilton, Douglas C. Burton, Munish Chandra Gupta, Justin S. Smith, Alexandra Soroceanu, Robert A. Hart, Brian Neuman, Christopher P. Ames, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticlepeer-review

Abstract

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively ('6 weeks), and postoperatively ('6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL (P '.001) and LOS (P =.0092). Postoperative complication presence and major postoperative complication were associated with reoperation (P '.001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores (P '.02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes (P '.05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

Original languageEnglish (US)
Pages (from-to)896-907
Number of pages12
JournalGlobal Spine Journal
Volume10
Issue number7
DOIs
StatePublished - Oct 1 2020

Keywords

  • Clavien-Dindo Scale
  • adult spinal deformity
  • complication classification
  • complications
  • major-minor
  • outcomes
  • patient-reported outcomes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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