TY - JOUR
T1 - Decreased rates of 30-day perioperative complications following ASD-corrective surgery
T2 - A modified Clavien analysis of 3300 patients from 2010 to 2014
AU - Passias, Peter G.
AU - Bortz, Cole A.
AU - Pierce, Katherine E.
AU - Segreto, Frank A.
AU - Horn, Samantha R.
AU - Vasquez-Montes, Dennis
AU - Lafage, Virginie
AU - Brown, Avery E.
AU - Ihejirika, Yael
AU - Alas, Haddy
AU - Varlotta, Christopher
AU - Ge, David H.
AU - Shepard, Nicholas
AU - Oh, Cheongeun
AU - DelSole, Edward M.
AU - Jankowski, Pawel P.
AU - Hockley, Aaron
AU - Diebo, Bassel G.
AU - Vira, Shaleen N.
AU - Sciubba, Daniel M.
AU - Raad, Michael
AU - Neuman, Brian J.
AU - Gerling, Michael C.
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2019/3
Y1 - 2019/3
N2 - The Clavien-Dindo grading allows for broad comparison of perioperative surgical complications, and a temporal analysis of complications following ASD-corrective surgery. NSQIP database was utilized from 2010 to 2014 to isolate patients. Complications were stratified by Clavien complication (Cc) grade, and patients grouped by highest Cc grade: I, II, III, IV, V. Secondary analysis grouped by minor (I, II, III) and severe (IV, V). Comorbidity burden was assessed with a NSQIP-modified Charlson Comorbidity Index (CCI) and frailty was measured with a 5-factor modified frailty index (mFI). From 2010 to 2014, 2971 patients (57 yrs, 58% F) underwent surgery for ASD (3.4 ± 4.1 levels; surgical approach: 46% anterior, 44% posterior, 10% combined), the rate of which increased 0.01% to 0.13. 32% suffered >1 complication. Patient breakdown by Cc grade: 0% I, 25% II, 3% III, 4% IV, 1% V. Severe Cc patients were more comorbid than minor Cc (CCI 2.8 vs 1.8), had longer operative times (394 min vs 251), and higher rates of osteotomy (29% vs 13%) and iliac fixation (16% vs 5%). Overall CCI (2.1–1.7) and perioperative complication rates (55–29%) decreased, despite increasing surgical invasiveness (2.8–4.5) and increasing frailty score (0.14 ± 0.15 vs 0.16 ± 0.16). Rates of Clavien grade II (39.80–22.20%) and IV (9.40–3.50%) complications also decreased, indicative of surgical improvements and effective preoperative patient selection. The decrease in CCI and increase in the modified frailty score may show that we are becoming more cognizant of discerning of comorbidities, but likely to not to have taken into account frailty, which may have an impact on future health socioeconomics.
AB - The Clavien-Dindo grading allows for broad comparison of perioperative surgical complications, and a temporal analysis of complications following ASD-corrective surgery. NSQIP database was utilized from 2010 to 2014 to isolate patients. Complications were stratified by Clavien complication (Cc) grade, and patients grouped by highest Cc grade: I, II, III, IV, V. Secondary analysis grouped by minor (I, II, III) and severe (IV, V). Comorbidity burden was assessed with a NSQIP-modified Charlson Comorbidity Index (CCI) and frailty was measured with a 5-factor modified frailty index (mFI). From 2010 to 2014, 2971 patients (57 yrs, 58% F) underwent surgery for ASD (3.4 ± 4.1 levels; surgical approach: 46% anterior, 44% posterior, 10% combined), the rate of which increased 0.01% to 0.13. 32% suffered >1 complication. Patient breakdown by Cc grade: 0% I, 25% II, 3% III, 4% IV, 1% V. Severe Cc patients were more comorbid than minor Cc (CCI 2.8 vs 1.8), had longer operative times (394 min vs 251), and higher rates of osteotomy (29% vs 13%) and iliac fixation (16% vs 5%). Overall CCI (2.1–1.7) and perioperative complication rates (55–29%) decreased, despite increasing surgical invasiveness (2.8–4.5) and increasing frailty score (0.14 ± 0.15 vs 0.16 ± 0.16). Rates of Clavien grade II (39.80–22.20%) and IV (9.40–3.50%) complications also decreased, indicative of surgical improvements and effective preoperative patient selection. The decrease in CCI and increase in the modified frailty score may show that we are becoming more cognizant of discerning of comorbidities, but likely to not to have taken into account frailty, which may have an impact on future health socioeconomics.
KW - Adult spinal deformity
KW - Clavien classification
KW - Medical complications
KW - Severity
KW - Surgical complications
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U2 - 10.1016/j.jocn.2018.10.104
DO - 10.1016/j.jocn.2018.10.104
M3 - Article
C2 - 30424970
AN - SCOPUS:85056296712
SN - 0967-5868
VL - 61
SP - 147
EP - 152
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -