Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Definitions of complications in spinal surgery are not clear. Therefore, the authors assessed a group of practicing spine surgeons and, through the surgeons' responses to an online and emailed survey, developed a simple definition of operative complications due to spinal surgery. To validate this assessment, the authors revised their survey to make it appropriate for a lay audience and repeated the assessment with a cohort of patients who underwent spine surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors surveyed a cohort of practicing spine surgeons via email and a web-based survey. Surgeons were presented with various complication scenarios and were asked to grade the presence or absence of a complication as well as complication severity, with responses limited to “major complication” and “minor complication/adverse event.” The authors administered a similar assessment, modified for lay persons, to patients in a spinal surgery clinic.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Complete responses were obtained from 229 surgeons; orthopedic surgeons comprised the majority of respondents (73%). The authors obtained completed surveys from 197 patients. Overall, there was consistent agreement between physicians and patients regarding the presence or absence of a complication in the majority of scenarios (8 [73%] of 11 scenarios with agreement that a complication was present). The overall kappa value, evaluating major versus minor complication, and presence or absence of a complication over the entire cohort, was fair (κ = 0.21). The authors found greater variation between the cohorts when evaluating complication severity. Patients were consistently more critical than physicians in the majority of scenarios in which a difference was evident. In 4 scenarios, patients were more likely than surgeons to deem the scenario a complication and to grade the complication as major versus minor (p &lt; 0.01). In 3 additional scenarios, patients were more likely than physicians to grade a major complication as opposed to minor complication (p &lt; 0.01). In only 1 scenario were patients less likely than physicians to report a complication (p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Comparing responses of spine surgeons and patients who underwent spinal surgery in assessing a group of common postoperative events, the authors found significant agreement on perception of presence of a complication in the majority of scenarios reviewed. However, patients were consistently more critical than surgeons when differences in reporting were found. The authors' data underscore the importance of reconciling differing opinions regarding complications through open discussions between physicians and patients to ensure accurate patient expectations of planned medical or surgical interventions.</jats:p></jats:sec>

Complications related to instrumentation in spine surgery: a prospective analysis

“…10 In the present study, we performed a prospective observational analysis using an easily reproducible grading system of complications previously validated by spine surgeons and spine surgery patients. 20 A comprehensive, ideal system for complication analysis would include this graduated complication severity score in addition to a patient-specific comorbidity profile. 7 Ultimately, this approach would allow patient comorbidities and procedural complexity to be integrated for the purpose of the development of a procedure-specific, risk-adjusted predictive model for complications in spinal surgery.…”

“…20 The definition of a complication used in this study was broad and included all perioperative medical adverse events, which were most often classified as minor complications (Table 1). Major complications were defined as events responsible for permanent sequela(e) or requiring further intervention, such as reoperation.…”

“…An easily reproducible complication definition was based on a prospective survey of spine surgeons and validated through parallel assessment of patients who underwent spinal surgery. 20 Based on the survey results, all adverse medical events were included in the assessment (typically as minor complications). An independent auditor graded all complications.…”

Comparison of ICD-9–based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting

“…We initially completed a prospective assessment of perioperative complications according to an independent examiner and a standardized definition of perioperative complications. 23 To assess the accuracy of ICD-9 reporting, we compared the results of our prospective series with the ICD-9-based data on HAC occurrence in the same patient cohort. A retrospective chart review was then completed, and the results of the different approaches were compared.…”

“…A standardized definition of "complication" would be beneficial. 23 Retrospective reviews are assumed to significantly underestimate complication incidence. Large ICD-9-based complication and HAC assessments may also significantly underestimate the incidence of spine surgery complications.…”