Influence of perioperative complication severity on 1- and 2-year outcomes of low back surgery

Abstract

BackgroundSeveral factors potentially influence outcomes of surgery, including perioperative complications. Complications may take many forms and the Clavien–Dindo (CD) classification is designed to categorize them by degree of severity. The aim of this study was to evaluate the influence of perioperative complications by severity categorization on the 1-and 2-year pain and disability outcomes for patients who received low back surgery.Materials and methodsData used for the study involved a purposive sample (N = 477; 8.1%) from a spine outcomes registry of 5876 patients who received spine surgery and encountered complications. All complications were categorized using the CD classification and were collapsed according to distribution frequencies, i.e., Grade I–II and Grade III–V. Adjusted and unadjusted regression analyses were used to determine the association between CD classification and 1- and 2-year outcomes.ResultsThe majority of surgical complications were Grade III−V (N = 358; 75.1%), with two incidences in which death occurred. For the unadjusted models, there were no significant associations between CD classification categorizations for 1-year outcomes; however, 2-year outcomes were significantly worse (P <0.05) for those with Grade III–V categorization. When adjusted and controlled for baseline characteristics, CD classification did not influence 1-or 2-year pain and disability outcomes.ConclusionsWhen control variables are considered, the severity of perioperative surgical complications does not appear to influence 1- or 2-year pain and disability outcomes.Level of evidenceLevel 4.

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

“…To date, few studies have evaluated the effect of complication severity on clinical outcomes [28][29][30]. Glassman et al analyzed a prospective multicenter database for adult spinal deformity to explore the effects of major and minor complications on 1-year disability, pain, postoperative quality of life and found that major complications, although rare, evidently deteriorated the quality of life [28].…”

“…Fritzell et al [29] found no significant differences of effects of major and minor complications on 2-years outcomes in three different types of fusion surgery. Grainger et al explored the relationship between severity of complications and outcomes in a larger sample of patients following Clavien-Dindo classification of complications and found that the severity of perioperative surgical complications does not appear to influence 1-or 2-year pain and disability outcomes [30]. Lambat et al confirmed, through a large retrospective study, that Oswestry Disability Index (ODI) at 2-year follow-up was not statistically different between patients having no complications, minor complications, or major complications.…”

Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina

“…In orthopedics; Sink et al adapted the DCC to hip surgery and showed a high interobserver and intraobserver reliability when compared different clinical scenarios of hip preservation surgery [ 11 ]. Additionally implementation of DCC in spine surgery also resulted in an important tool to measure surgical outcomes [ 12 ]. However, to the best of the author's knowledge, the DCC has not been used in a department of orthopedic surgery to systematically record global postoperative complications.…”

“…It has been used in other subspecialties (Urology [ 8 ], Nephrology [ 9 ], and Gastroenterology [ 10 ]). Although it has been occasionally utilized to classify postoperative complications following hip and spine surgery [ 11 , 12 ], it has not been universally used in a register of postoperative complications after all the surgeries of an orthopedic unit.…”

Adverse Events Capture Systems, Checklists and Teamwork as Relevant Tools to Reduce Complications and Increase Patients’ Safety in Spinal Surgery

“…To date, few studies have evaluated the effect of complications on clinical outcomes [27][28][29]. Glassman et al analyzed a prospective multicenter database for adult spinal deformity to investigate the effects of major and minor complications on disability, pain, postoperative quality of life at 1 year follow up and found that major complications negatively affected the quality of life [27].…”