Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes.

Autor:	Klineberg EO; 70083UC Davis Health System, Sacramento, CA, USA., Passias PG; 25061NYU Hospital for Joint Diseases, New York, NY, USA., Poorman GW; 25061NYU Hospital for Joint Diseases, New York, NY, USA., Jalai CM; 25061NYU Hospital for Joint Diseases, New York, NY, USA., Atanda A; 25061NYU Hospital for Joint Diseases, New York, NY, USA., Worley N; 25061NYU Hospital for Joint Diseases, New York, NY, USA., Horn S; 25061NYU Hospital for Joint Diseases, New York, NY, USA., Sciubba DM; 1466Johns Hopkins, Baltimore, MD, USA., Hamilton DK; 6614University of Pittsburgh, Pittsburgh, PA, USA., Burton DC; 21638University of Kansas Medical Center, Kansas City, KS, USA., Gupta MC; Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA., Smith JS; 12350University of Virginia Health System, Charlottesville, VA, USA., Soroceanu A; 2129University of Calgary, Calgary, Alberta, Canada., Hart RA; Swedish Neuroscience Institute, Seattle, WA, USA., Neuman B; 1466Johns Hopkins, Baltimore, MD, USA., Ames CP; 70083University of California, San Francisco, CA, USA., Schwab FJ; 25062Hospital for Special Surgery, New York, NY, USA., Lafage V; 25062Hospital for Special Surgery, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Global spine journal [Global Spine J] 2020 Oct; Vol. 10 (7), pp. 896-907. Date of Electronic Publication: 2020 Jul 30.
DOI:	10.1177/2192568220937473
Abstrakt:	Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.
Databáze:	MEDLINE
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