Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P106. Grading of complications following cervical deformity-corrective surgery: are existing classification systems applicable?

Abstract

BACKGROUND CONTEXT Despiteresearch assessing complication rates in cervical deformity (CD)-corrective surgery, there is lack of consensus regarding how to classify and stratify surgical CD complications by severity. Validated for general surgery, the Clavien-Dindo complication classification system allows for broad comparison of postoperative complications; however, the applicability of this system is unclear in CD-specific populations. PURPOSE Assess the impact of complication type and Clavien complication grade (Cc) on patient improvement markers and health-related quality of life (HRQL) outcomes in surgical CD patients. STUDY DESIGN/SETTING Retrospective review of prospective multicenter CD-database. PATIENT SAMPLE A total of 153 surgical CD patients OUTCOME MEASURES Complication type; complication severity by Cc grade; HRQL scores. METHODS Surgical CD patients (C2–C7 Cobb>10°, CL>10°, cSVA>4 cm, and/or CBVA>25°) >18years with baseline (BL) and postop clinical data. Primary OUTCOME MEASURES: complication type (renal, infection, cardiac, pulmonary, gastrointestinal, neurologic, musculoskeletal, implant-related, radiographic, operative, wound) and Cc grade (I, II, III, IV, and V). Secondary outcomes included EBL, LOS, reop, and HRQL score. Univariate analysis assessed the impact of complication type and Cc grade on improvement markers and 1-year postop(1Y) HRQL outcomes. RESULTS A total of 153 patients (61±10 years, 61%F, BMI: 29.8±8.0) underwent surgery for CD (8.1±4.6 lvls fused; surgical approach included 48% posterior, 18% anterior, 34% combined). Overall, 63% of patients suffered at least one complication. Patient breakdown by complication type: renal (2.0%), infection (9.1%), cardiac (7.8%), pulmonary (3.9%), gastrointestinal (GI; 1.9%), neurological (28.8%), musculoskeletal (0.0%), implant-related (3.9%), radiographic (21.5%), operative (7.8%), and wound (5.2%). Of complication types evaluated, only infection and operative complications were associated with increased EBL (p=.003 and p=.032, respectively), while cardiac (p CONCLUSIONS In a population of 153 surgical cervical deformity patients, increasing complication severity, as assessed by the Clavien-Dindo classification system, was not associated with increased EBL, inpatient LOS, or inferior 1-year postop HRQL outcomes. By type, cardiac, neurological, and GI complications were associated with increased LOS, and operative complications were associated with increased EBL. Radiographic and neurological complications were also associated with inferior 1-year HRQL outcomes. These results suggest a need for modification of the Clavien system to increase applicability and utility in CD-specific patient populations.