Development and Validation of a Multidomain Surgical Complication Classification System for Adult Spinal Deformity

Abstract

Study Design. Prospective analysis of example cases Objective. The aim of this study was to analyze the accuracy and repeatability of a new comprehensive classification system for capturing complications data in adult spinal deformity. Summary of Background Data. Complications are common in adult spinal deformity surgery. However, no consensus exists on the definition or classification of complications in adult spinal deformity surgery. The lack of consensus significantly limits understanding of complications’ effects on outcomes in surgery for adult spinal deformity. Methods. Using a Delphi method, members of the International Spine Study Group, AO Spine, and the European Spine Study Group collaborated to develop an adult spinal deformity classification system. The multidomain classification system accounts for medical complications (cancer, cardiopulmonary, central nervous system, gastrointestinal, infectious, musculoskeletal, renal) and surgical complications (implant complications, radiographic complications, neurologic events, intraoperative events, and wound complications). Seventeen individuals (“event readers”), including spine surgeons, trainees, and research coordinators, used the new classification system two separate times to analyze complications in ten example cases. The accuracy and repeatability of the classification system were subsequently calculated based on the providers’ responses for the example cases. Results. The 10 example cases included 22 complications. Nearly 95% of complications were captured by >95% of the event readers. The system demonstrated good repeatability of 86.9% between the first and second set of responses provided by event readers. Conclusion. The ISSG-AO Multi-Domain Spinal Deformity Complication Classification System for Adult Spinal Deformity demonstrated good accuracy and repeatability among both surgeons and research coordinators in capturing complications in adult spinal deformity surgery. The ISSG-AO system may be applied to help better understand the impact of complications on outcomes and costs in adult spinal deformity surgery. Level of Evidence: 5

Surgical Factors and Treatment Severity for Perioperative Complications Predict Hospital Length of Stay in Adult Spinal Deformity Surgery

“…Recent data has shown the ISSG-AO Adult Spinal Deformity Complications Classification System is reliable and reproducible. 10,13 Although this study was not intended to compare specific complication classification systems, an important difference between previous classification systems, such as Clavien-Dindo and SAVES and the ISSG-AO system, is that the ISSG-AO system was designed specifically for capturing and classifying complications in ASD. In contrast, the Clavien-Dindo system was developed for general surgery, and the SAVES is not specific to ASD.…”

“…One result of this effort has been the International Spine Study Group-AO (ISSG-AO) Multi-Domain Surgical Complication Classification System for Adult Spinal Deformity, 10 which organizes complications by type (medical or surgical) with four modifiers: neurological impact, timing of complication diagnosis, intervention severity, and resolution sta-tus. 10,13 Within the ISSG-AO system, intervention severity is classified as none, minor, moderate, or severe. Although the complication rates following ASD surgery are high, 7,8 our study showed most in-hospital complications required no intervention (14.9%) or minor intervention (68.6%).…”

“…18,19 Understanding the impact of complication intervention severity is important, and complication severity has been included in a recently developed ASD complication classification system. 10 Assessing the implications of complication intervention is especially relevant in ASD surgery, which is complex with substantial risk for perioperative morbidity including prolonged hospitalization. The mean LOS after ASD surgery has been reported to be approximately 8 days, but varies significantly depending on multiple medical and surgical factors.…”

“…Given the need for an improved ASD complication classification system, a multidisciplinary effort utilizing a Delphi approach was utilized to develop a comprehensive complication classification system. 10 The resulting system grades complications by type (medical or surgical) with four complication modifiers: neurological impact, timing of complication diagnosis, intervention severity, and resolution status (Figures 1 and 2). [10][11][12][13] Although each complication modifier is intended to increase classification granularity and potentially improve surgeons' ability to understand and predict the impact of complications, there is a lack of data demonstrating the impact of intervention severity on patient outcomes.…”

“…Given the need for an improved ASD complication classification system, a multidisciplinary effort utilizing a Delphi approach was utilized to develop a comprehensive complication classification system 10 . The resulting system grades complications by type (medical or surgical) with four complication modifiers: neurological impact, timing of complication diagnosis, intervention severity, and resolution status (Figures 1 and 2).…”