Complications in Neurosurgery: Application of Landriel Ibañez Classification and Preliminary Considerations on 1000 Cases

Abstract

To study various complications in neurosurgery and their impact on the health related quality of life (HRQOL) and proposal of a complication grading system in neurosurgery that is based on or at least incorporates HRQOL.The study was conducted in the Department of Neurosurgery at Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Patients operated between June 2018 to July 2019 and after satisfying the “inclusion criteria” were included in the study, those patients who developed complication(s) after surgery as per our “definition of complication” constituted the “study group” and were followed-up for maximum three months. Diseases were categorised, complications initially graded as per Landriel scale. For measuring the health related quality of life (HRQOL), EUROQOL (EQ-5D-5L-5L) scale was used and HRQOL was noted at admission, after complication, at discharge and at follow-up and the results were analysed to measure the impact of complication on HRQOL.Out of total of 2186 patients operated, 212 developed complications (16.48%), cranium cases having 3.64 times risk than spine cases. Brain tumours, vascular disorders and spinal tumours had highest relative risk, age and sex doesn’t seem to have any significant effect on rate of complication, respiratory complications f/b CSF leak and cranial nerve palsies were most common complication. Sudden onset cardiac arrest, tumour bed hematoma, hydrocephalus, limb weakness and respiratory distress most severely affected the HRQOL.Treatment based grading of complications do not efficiently reflect the correlation with impact on HRQOL. EQ-5D-5L Index score can be used as a HRQOL scale and complication based HRQOL is a must in this modern era. Landriel scale performed satisfactorily as a group when considering HRQOL, but has lacunae when considered on individual patient basis, for which we propose HRQOL based SVIMS COMPLICATION GRADING and MODIFIED LANDRIEL SCALE incorporating HRQOL.