Grading of complications after cervical deformity-corrective surgery: Are existing classification systems applicable?

Cole A. Bortz; Peter G. Passias; Frank A. Segreto; Samantha R. Horn; Renaud Lafage; Justin S. Smith; Breton G. Line; Gregory M. Mundis; Michael P. Kelly; Paul Park; Daniel M. Sciubba; D. Kojo Hamilton; Jeffrey L. Gum; Douglas C. Burton; Robert A. Hart; Frank J. Schwab; Shay Bess; Christopher Shaffrey; Eric O. Klineberg

doi:10.1097/BSD.0000000000000748

Grading of complications after cervical deformity-corrective surgery: Are existing classification systems applicable?

Cole A. Bortz, Peter G. Passias, Frank A. Segreto, Samantha R. Horn, Renaud Lafage, Justin S. Smith, Breton G. Line, Gregory M. Mundis, Michael P. Kelly, Paul Park, Daniel M. Sciubba, D. Kojo Hamilton, Jeffrey L. Gum, Douglas C. Burton, Robert A. Hart, Frank J. Schwab, Shay Bess, Christopher Shaffrey, Eric O. Klineberg

Research output: Contribution to journal › Article

4 Scopus citations

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.

Original language	English (US)
Pages (from-to)	263-268
Number of pages	6
Journal	Clinical Spine Surgery
Volume	32
Issue number	6
DOIs	https://doi.org/10.1097/BSD.0000000000000748
State	Published - Jul 1 2019
Externally published	Yes

Keywords

Clavien
Clavien-Dindo
cervical deformity
classification
complications

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine
Clinical Neurology

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Bortz, C. A., Passias, P. G., Segreto, F. A., Horn, S. R., Lafage, R., Smith, J. S., Line, B. G., Mundis, G. M., Kelly, M. P., Park, P., Sciubba, D. M., Hamilton, D. K., Gum, J. L., Burton, D. C., Hart, R. A., Schwab, F. J., Bess, S., Shaffrey, C., & Klineberg, E. O. (2019). Grading of complications after cervical deformity-corrective surgery: Are existing classification systems applicable? Clinical Spine Surgery, 32(6), 263-268. https://doi.org/10.1097/BSD.0000000000000748

Grading of complications after cervical deformity-corrective surgery : Are existing classification systems applicable? / 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.

In: Clinical Spine Surgery, Vol. 32, No. 6, 01.07.2019, p. 263-268.

Research output: Contribution to journal › Article

Bortz, CA, Passias, PG, Segreto, FA, Horn, SR, Lafage, R, Smith, JS, Line, BG, Mundis, GM, Kelly, MP, Park, P, Sciubba, DM, Hamilton, DK, Gum, JL, Burton, DC, Hart, RA, Schwab, FJ, Bess, S, Shaffrey, C & Klineberg, EO 2019, 'Grading of complications after cervical deformity-corrective surgery: Are existing classification systems applicable?', Clinical Spine Surgery, vol. 32, no. 6, pp. 263-268. https://doi.org/10.1097/BSD.0000000000000748

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. / Grading of complications after cervical deformity-corrective surgery : Are existing classification systems applicable?. In: Clinical Spine Surgery. 2019 ; Vol. 32, No. 6. pp. 263-268.

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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.}",

year = "2019",

month = jul,

day = "1",

doi = "10.1097/BSD.0000000000000748",

language = "English (US)",

volume = "32",

pages = "263--268",

journal = "Clinical Spine Surgery",

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TY - JOUR

T1 - Grading of complications after cervical deformity-corrective surgery

T2 - Are existing classification systems applicable?

AU - Bortz, Cole A.

AU - Passias, Peter G.

AU - Segreto, Frank A.

AU - Horn, Samantha R.

AU - Lafage, Renaud

AU - Smith, Justin S.

AU - Line, Breton G.

AU - Mundis, Gregory M.

AU - Kelly, Michael P.

AU - Park, Paul

AU - Sciubba, Daniel M.

AU - Hamilton, D. Kojo

AU - Gum, Jeffrey L.

AU - Burton, Douglas C.

AU - Hart, Robert A.

AU - Schwab, Frank J.

AU - Bess, Shay

AU - Shaffrey, Christopher

AU - Klineberg, Eric O.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

KW - Clavien

KW - Clavien-Dindo

KW - cervical deformity

KW - classification

KW - complications

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