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. 2022 Jan 19:2:100860.
doi: 10.1016/j.bas.2022.100860. eCollection 2022.

Neurosurgery outcomes and complications in a monocentric 7-year patient registry

Johannes Sarnthein  1 , Victor E Staartjes  1 , Luca Regli  1 ; Neurosurgery-Registry consortium
Collaborators, Affiliations

Neurosurgery outcomes and complications in a monocentric 7-year patient registry

Johannes Sarnthein et al. Brain Spine. .

Abstract

Introduction: Capturing adverse events reliably is paramount for clinical practice and research alike. In the era of "big data", prospective registries form the basis of clinical research and quality improvement.

Research question: To present results of long-term implementation of a prospective patient registry, and evaluate the validity of the Clavien-Dindo grade (CDG) to classify complications in neurosurgery.

Materials and methods: A prospective registry for cranial and spinal neurosurgical procedures was implemented in 2013. The CDG - a complication grading focused on need for unplanned therapeutic intervention - was used to grade complications. We assess construct validity of the CDG.

Results: Data acquisition integrated into our hospital workflow permitted to include all eligible patients into the registry. We have registered 8226 patients that were treated in 11994 surgeries and 32494 consultations up until December 2020. Similarly, we have captured 1245 complications on 6308 patient discharge forms (20%) since full operational status of the registry. The majority of complications (819/6308 ​= ​13%) were treated without invasive treatment (CDG 1 or CDG 2). At discharge, there was a clear correlation of CDG and the Karnofsky Performance Status (KPS, rho ​= ​-0.29, slope -7 KPS percentage points per increment of CDG) and the length of stay (rho ​= ​0.43, slope 3.2 days per increment of CDG).

Discussion and conclusion: Patient registries with high completeness and objective capturing of complications are central to the process of quality improvement. The CDG demonstrates construct validity as a measure of complication classification in a neurosurgical patient population.

Keywords: Adverse events; Morbidity and mortality rounds; Quality monitoring.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flowchart of documenting a complication in the patient registry. The diagram is shows how a complication is described in the case report form at discharge (dCRF) and who the complication is classified in a Clavier-Dindo grade (CDG).
Fig. 2
Fig. 2
Cumulative sum of case report forms (CRF) Case report forms (CRF) for patients, admissions, surgeries, discharges and follow-ups. Complications registered at discharge (black line).
Fig. 3
Fig. 3
Complications at discharge. (A) Distribution of grades in the Clavien Dindo classification system (CDG). (B) Karnofsky Performance Status Scale (KPS) as a function of grade of the complications (rho ​= ​-0.29, slope -7 KPS percentage points per increment of CDG). (C) Duration of hospital stay after surgery (rho ​= ​0.43, slope 3.2 days per increment of CDG). (D) Distribution of adverse events (AE) across patients with different KPS. The majority of patients with KPS ≥90 (89%) do not show a complication at discharge.
See this image and copyright information in PMC

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