Validating a therapy-oriented complication grading system in lumbar spine surgery: a prospective population-based study

Abstract

The aim of the present study was to validate a therapy-oriented complication grading system in a well-defined neurosurgical patient population in which complications may entrain neurological deficits, which are severe but not treated. The prospective patient registry of the Department of Neurosurgery, University of Zurich provides extensive population-based data. In this study we focused on complications after lumbar spine surgeries and rated their severity by Clavien-Dindo grade (CDG). Analyzing 138 consecutive surgeries we noted 44 complications. As to treatment, CDG correlated with the length of hospital stay and treatment cost. As to patient outcome, CDG correlated with performance and outcome (McCormick). The present study demonstrates the correlation between outcome scales and the CDG. While the high correlation of CDG with costs seems self-evident, the present study shows this correlation for the first time. Furthermore, the study validates the CDG for a surgical subspecialty. As a further advantage, CDG registers any deviation from the normal postoperative course and allows comparison between surgical specialties.

Figure 1

Effect of the severity of complication noted at discharge or at 6 week follow-up. (A) Distribution of the 45 complications registered up to the first 6 weeks after discharge. (B) McCormick Grade. Lines are linear least square fits (rho = 0.24, p = 0.005, 0.16 McCormick points per increment of CDG). (C) Karnofsky Performance Status Scale (KPS, rho = −0.19, p = 0.025, −1.3 KPS points per increment of CDG). (D) Length of stay in hospital (rho = 0.40, p < 0.001, 1.8 days per increment of CDG). (E) Relative costs of treatment and treatment cost (rho = 0.45, p < 0.001, 0.4 cost units per increment of CDG).