Surgeon Perceptions and Reported Complications in Spine Surgery
- 1 April 2010
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 35 (Supplement), S9-S21
- https://doi.org/10.1097/brs.0b013e3181d830de
Abstract
Systematic review. To define the term “complications” from the spine surgery literature and contrast this with definitions from other federal institutions, to summarize the incidence of adverse events in cervical, thoracic, and lumbar spine surgery, to include the factors that contribute to these events, and to determine the relationship between complications and patient centered outcomes. Efforts to understand and reduce complications in medicine, and spine surgery in particular have been hampered as a result of the lack of a meaningful and universally acceptable definition. The complex field of spine surgery has been a particularly challenging area for the development of a consensus to constructively describe these “undesirable/unanticipated developments arising during or out of the delivery of health care.” Furthermore, an overall understanding of expected complication rates after major spine surgery is lacking. A systematic review of the English literature was undertaken for articles published between 1990 and December 2008. Electronic and federal databases and reference lists of key articles were searched to identify articles defining complications and reporting rates of spine surgical complications. Two independent reviewers assessed the level of evidence quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria and disagreements were resolved by consensus. The definitions for complications in the spine literature and federal agencies are inconsistent and at times conflicting. Mortality rates for cervical spine and lumbar spine surgery are <1%. For thoracic spine surgery, rates range from 0.3% to 7%. Complication rates range from 5% to 19%, 7% to 18%, and 4% to 14% after cervical, thoracic, and lumbar spine surgery, respectively. Findings from a single study indicate that major complications may have an impact on 1-year self-perceived general health. However, minor complications may not. We define a complication as an unintended and undesirable diagnostic or therapeutic event that may impact the patient's care. Complications should be recorded and analyzed relative to disease severity, patient comorbidities, and ultimately their effect on patient outcomes. Further work needs to be done to develop a complication risk impact index that has the ability to help us assess and communicate the interaction of patient cormobidities and complication severity on patient centered outcomes.Keywords
This publication has 28 references indexed in Scilit:
- Methods for the Systematic Reviews on Patient Safety During Spine SurgerySpine, 2010
- Diabetes and Perioperative Outcomes Following Cervical Fusion in Patients With MyelopathySpine, 2008
- Obesity and spine surgery: relation to perioperative complicationsJournal of Neurosurgery: Spine, 2007
- Reoperation Rates Following Lumbar Spine Surgery and the Influence of Spinal Fusion ProceduresSpine, 2007
- Complications and Mortality Associated With Cervical Spine Surgery for Degenerative Disease in the United StatesSpine, 2007
- Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluationBMC Musculoskeletal Disorders, 2006
- Intraoperative Adverse Events and Related Postoperative Complications in Spine Surgery: Implications for Enhancing Patient Safety Founded on Evidence-Based ProtocolsSpine, 2006
- National Trends in Surgical Procedures for Degenerative Cervical Spine Disease: 1990–2000Neurosurgery, 2005
- INTRODUCING LEVELS OF EVIDENCE TO THE JOURNALPublished by Ovid Technologies (Wolters Kluwer Health) ,2003
- Characteristics in Medicare Beneficiaries Associated with Reoperation After Lumbar Spine SurgerySpine, 1994