학술논문
Modified Clavien-Dindo-Sink Classification System for operative complications in adult spine surgery.
Document Type
Academic Journal
Author
Ridolfi D; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Oyekan AA; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Tang MY; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Chen SR; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Como CJ; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Dalton J; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Gannon EJ; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; 3Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska.; Jackson KL; 4Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia; and.; Bible JE; 5Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.; Kowalski C; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; de Groot SJ; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Donaldson WF; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Lee JY; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.; Shaw JD; 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania.
Source
Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 101223545 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1547-5646 (Electronic) Linking ISSN: 15475646 NLM ISO Abbreviation: J Neurosurg Spine Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: Currently there is no standardized mechanism to describe or compare complications in adult spine surgery. Thus, the purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery.
Methods: The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss' and Cohen's kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively.
Results: Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785-0.908) and 0.852 (95% CI 0.791-0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644-0.912), 0.698 for grade II (95% CI 0.564-0.832), 0.861 for grade III (95% CI 0.727-0.996), 0.845 for grade IV-A (95% CI 0.711-0.979), 0.962 for grade IV-B (95% CI 0.828-1.097), and 0.960 for grade V (95% CI 0.826-1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944-0.999) for rater 1, 0.963 (95% CI 0.926-1.001) for rater 2, and 0.926 (95% CI 0.869-0.982) for rater 3.
Conclusions: The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.
Methods: The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss' and Cohen's kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively.
Results: Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785-0.908) and 0.852 (95% CI 0.791-0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644-0.912), 0.698 for grade II (95% CI 0.564-0.832), 0.861 for grade III (95% CI 0.727-0.996), 0.845 for grade IV-A (95% CI 0.711-0.979), 0.962 for grade IV-B (95% CI 0.828-1.097), and 0.960 for grade V (95% CI 0.826-1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944-0.999) for rater 1, 0.963 (95% CI 0.926-1.001) for rater 2, and 0.926 (95% CI 0.869-0.982) for rater 3.
Conclusions: The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.