Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery

Camino-Willhuber, Gastón; Elizondo, Cristina; Slullitel, Pablo

doi:10.1177/2192568218792053

Cited by 72 publications

(45 citation statements)

References 35 publications

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“…[9][10][11] Readmission after surgical procedures is common and can affect between 3% and 25% of patients postoperatively. 12,13 Patients considering surgical interventions are concerned with functional and cognitive outcomes after surgery. Readmission to the hospital and unplanned reoperations represent major events for patients and have considerable impacts on all healthcare stakeholders, particularly Copyright 2021 by International Society for the Advancement of Spine Surgery.…”

Section: Introductionmentioning

confidence: 99%

Complications After Adult Spinal Deformity Surgeries: All Are Not Created Equal

et al. 2021

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Background: Data on timing of complications are important for accurate quality assessments. We sought to better define pre-and postdischarge complications occurring within 90 days of adult spinal deformity (ASD) surgery and quantify the effect of multiple complications on recovery. Methods: We performed a review of 1040 patients who underwent ASD surgery (age: 46 6 23; body mass index: 25 6 7, American Society of Anesthesiologists [ASA] score: 2.5 6 0.6, levels: 10 6 4, revision: 9%, 3-column osteotomy: 13%). We assessed pre-and postdischarge complications and risk factors for isolated versus multiple complications, as well as the impact of multiple complications. Results: The 90-day complication rate was 17.7%. 85 patients (8.2%) developed a predischarge complication, most commonly ileus (12%), and pulmonary embolism (PE; 7.1%). The most common causes of predischarge unplanned reoperation were neurologic injury (12.9%) and surgical site drainage (8.2%). Predictors of a predischarge complication included smoking (odds ratio [OR]:2.2, P ¼ .02), higher ASA (OR:1.8, P ¼ .008), hypertension (HTN; OR:2.0, P ¼ .004), and iliac fixation (OR: 4.3, P , .001). Ninety-nine patients (9.5%) developed a postdischarge complication, most commonly infection (34%), instrumentation failure (13.4%), and proximal junctional failure (10.4%). Predictors of postdischarge complications included chronic obstructive pulmonary disease (OR: 3.6, P , .0001), congestive heart failure (OR: 4.4, P ¼ .016), HTN (OR: 2.3, P , .0001), and multiple rod construct (OR: 1.8, P ¼ .02). Patients who developed multiple complications (9.3%) had a longer length of stay, and increased risk for readmission and unplanned reoperation. Conclusions: Knowledge regarding timing of postoperative complications in relation to discharge may better inform quality improvement measures. PE and implant-related complications play a prominent role in perioperative complications and need for readmission, with several modifiable risk factors identified.

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Section: Introductionmentioning

confidence: 99%

Complications After Adult Spinal Deformity Surgeries: All Are Not Created Equal

et al. 2021

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“…Treatment strategies in elderly patients with low back pain that do not respond to conservative treatment are challenging due to some risk factors such as increased medical comorbidities and therefore, a higher surgical risk. [16][17][18] In addition, the higher prevalence of osteoporosis in this population increases the risk of fracture and implant loosening with standard fusion treatments. [19][20][21][22] The introduction of percutaneous discoplasty by Varga et al 8 in 2013 for the treatment of low back pain secondary to advanced degenerative disc disease has opened a new concept of minimal invasive treatment to decrease pain and disability in patients with high surgical risk.…”

Section: Discussionmentioning

confidence: 99%

Development of a New Therapy-Oriented Classification of Intervertebral Vacuum Phenomenon With Evaluation of Intra- and Interobserver Reliabilities

Camino-Willhuber

Bendersky

Cicco

et al. 2020

Global Spine Journal

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Study Design: Diagnostic study, level of evidence III. Objectives: Low back pain is a common cause of disability among elderly patients. Percutaneous discoplasty has been developed as a tool to treat degenerative disease when conservative management is not successful. Indications for this procedure include low back pain and the presence of vacuum phenomenon. The objective of this study was to describe a new classification of vacuum phenomenon based on computed tomography scan in order to improve the indications for percutaneous discoplasty. Methods: We developed a classification of vacuum phenomenon based on computed tomography scan images. We describe 3 types of vacuum based on the relationship between vacuum and the superior/inferior endplates and 2 subtypes based on the presence of significant subchondral sclerosis. A validation study was conducted selecting 10 orthopedic residents with spine surgery training to analyze 25 vacuum scenarios. Inter- and intraobserver reliabilities were assessed through the Fleiss’s and Cohen’s kappa statistics, respectively. Results: The overall Fleiss’s κ value for interobserver reliability was 0.85 (95% CI 0.82-0.86) in the first reading and 0.93 (95% CI 0.92-0.95) in the second reading. Cohen’s κ for intraobserver reliability was 0.88 (95% CI 0.77-0.99). Conclusion: The new classification has shown almost perfect inter- and intraobserver reliabilities for grading the vacuum phenomenon and could be an important tool to improve the indications for percutaneous cement discoplasty.

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“…The original classification of Clavien-Dindo was previously used at our institution by some of the authors of this manuscript [19][20] , resulting useful in terms for showing the prevalence of complications; however, several limitations were found, mainly because the majority of scenarios were developed for abdominal surgery being difficult to extrapolate to certain orthopedic settings. Bellut et al 21 applied the Clavien-Dindo classification scheme to lumbar spine surgery observing a direct correlation between outcome scales, hospital length of stay and complication grades.…”

Section: Discussionmentioning

confidence: 99%

Validation of a modified Clavien-Dindo Classification for postoperative complications in orthopedic surgery

Camino-Willhuber

Slullitel

Zamboni

et al. 2020

Rev Fac Cien Med Univ Nac Cordoba

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Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoperative course. Reporting of PCs remains a challenge, multiple classification systems have been proposed, however these have not been validated across surgical specialties. Clavien and Dindo (DCCS) developed a system for General Surgery and has been adopted in different fields. Nonetheless, this classification has not been adapted to Orthopedics. The objective of this study was to adapt the Clavien-Dindo classification to orthopedic scenarios and to determine the intra and interobserver reliability. Methods: The designer team adapted the Clavien Dindo classification to orthopedic scenarios. Ten orthopedic observers with different degrees of training and experience were selected to evaluate the classification. 48 simulated clinical scenarios of complications and another negative outcomes such as failure to cure and sequelae were sent by electronic format independently. A second round of scoring was performed 30 days later to assess the intraobserver concordance. Results: We found a high interobserver and intraobserver reliability for both the first and second evaluation (Kappa 0.88 and 0.91, respectively). In addition, the intraobserver analysis showed a very good correlation (Kappa 0.93). Discussion: The DCCS classification has been developed for general surgery and has been widely applied in the different surgical subspecialties. In Orthopedics, this classification was validated to hip and pediatric surgery. Therefore, our study involved an adaptation of the classification to general and specific orthopedic scenarios of the different orthopedic subspecialties. This classification may be a useful tool for documenting complications in orthopedic surgery. Keywords: postoperative complications; orthopedics; health systems

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Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery

Cited by 72 publications

References 35 publications

Complications After Adult Spinal Deformity Surgeries: All Are Not Created Equal

Complications After Adult Spinal Deformity Surgeries: All Are Not Created Equal

Development of a New Therapy-Oriented Classification of Intervertebral Vacuum Phenomenon With Evaluation of Intra- and Interobserver Reliabilities

Validation of a modified Clavien-Dindo Classification for postoperative complications in orthopedic surgery

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