@article{adf946e5ebb64aee93abd42ce13848b7,
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 patientsBackground: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 = "Clavien, Clavien-Dindo, cervical deformity, classification, complications",
author = "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 O.}",
note = "Funding Information: P.G.P.: personal consulting fees—Spinewave and Medicrea; teaching arrangements—Zimmer-Biomet and Globus; membership to the scientific advisory board of Allosource, research study funding—Aesculap; grant to the institution—CSRS; all outside the submitted work. R.L.: reports grants— Depuy Synthes Spine, outside the submitted work. J.S.S.: consulting fees—reports Depuy Synthes, Medtronic, Stryker; royalties—Zimmer-Biomet, all outside the submitted work. D.M.S.: consulting fees outside the work—Medtronic. J.L.G.: royalties—acuity; consulting—Medtronic, DePuy, Alphatec, Stryker, Acuity, K2M, Nuvasive; speaking and/or teaching arrangements—Pacira Pharmaceuticals; honorarium and research support (investigator salary, staff/materials)—Integra, Intellirod Spine Inc., Pfizer, International Spine Study Group Foundation, Norton Healthcare; grants —Fischer Owen Funds, all outside the submitted work. D.C.B.: royalties—DePuy Spine; consulting—DePuy Spine; Board of Directors—Inter-national Spine Study Group, Scoliosis Research Society, University of Kansas Physicians; research support—DePuy Spine, Bioventus, Pfizer, all outside the submitted work. R.A.H.: consulting—DePuy; research support—DJO, Seeger, K2M, DePuy, NuVasive, all outside the submitted work. F.J.S: speaking/teaching, consulting, royalties/patents—Zimmer Biomet, NuVasive, K2M, MSD; speaking/teaching, consulting—Medicrea; Board of Directors, shareholder—Nemaris, all outside the submitted work. S.B.: royalties—K2 Medical, Pioneer; consulting—Allosource, K2 Medical; Scientific Advisory Board—Allosource; grants—DePuy Synthes, Medtronic, K2 Medical, NuVasive, all outside the submitted work. C.S.: royalties, patents, consultant—Medtronic, Nuvasive, stock holder Zimmer Biomet; consultant—K2M, Stryker, In Vivo; grants—NIH, Department of De-fense, ISSG, DePuy Synthes, AOSpine, all outside the submitted work. E.O.K.: consulting—DePuy Synthes, Stryker, Springer, Trevana; honoraria, fellowship support—AOSpine; honoraria—K2M, all outside the submitted work. The remaining authors declare no conflict of interest. Funding Information: Supported by Grant from DePuy Synthes. Publisher Copyright: {\textcopyright} 2018 Wolters Kluwer Health Inc. All rights reserved.",
year = "2019",
month = jul,
day = "1",
doi = "10.1097/BSD.0000000000000748",
language = "English (US)",
volume = "32",
pages = "263--268",
journal = "Clinical Spine Surgery",
issn = "2380-0186",
publisher = "Lippincott Williams and Wilkins",
number = "6",
}