Editorial

Quality Assessment for Reporting Complications and Adverse Events in Spinal Surgery: A Proposed 5-Item Checklist

BACKGROUND

Reporting complications and/or adverse events after spinal surgical procedures enables the estimation of their prevalence and of their impact on patient outcomes. However, the documentation of complications is relatively infrequent and highly heterogeneous. The purpose of this study was to evaluate the quality of complication and adverse event reporting in spinal surgery literature.

METHODS

A systematic review of the literature from 5 international, peer-reviewed, indexed spinal journals was performed. Included studies were published between January and December 2020 and reported the surgical results of spinal procedures. Data on the level of evidence and study design were collected and analyzed as well as whether the studies were single-center or multicenter studies. The quality of complication reports was evaluated through a 5-item checklist, with 5 questions divided into 3 parts: definition, evaluation, and report.

RESULTS

Complications associated with spinal surgical procedures were reported in 292 studies. According to the level of evidence, significantly higher reporting quality was seen in level I and II studies compared with level III and IV studies (P = 0.003). Regarding the 5-item checklist, 49% (143/292) of studies fulfilled the definition section, 16.4% (48/292) fulfilled the evaluation section, and 92% (270/292) fulfilled the report section.

CONCLUSIONS

Overall quality assessment when reporting complications in surgical spinal studies showed that only 13% (38/292) of publications that reported complications as part of the outcomes exhibited all items of the 5-item checklist. Additionally, significantly better reports were observed in level I studies compared with level II-IV studies.

Retrospective single-centre series of 1300 consecutive cases of outpatient cervical spine surgery: complications, hospital readmissions, and reoperations

Background: Outpatient surgery is becoming more common and is more cost-effective than inpatient surgery. Nonetheless, many surgeons and health care administrators are still hesitant to accept outpatient surgery for cervical degenerative spinal disease (C-DSD). This study assesses the types and rates of complications, hospital admissions, and reoperations after outpatient surgery of C-DSD.Methods: Complications, hospital admissions within 90 days of surgery, and reoperations within one year of surgery were recorded retrospectively in 1300 outpatients undergoing microsurgical decompression for C-DSD at the Oslofjord Clinic from 2008 to 2017. The surgical procedures performed were anterior cervical decompression and fusion (ACDF) in 1083 patients and posterior cervical foraminotomy in 217 patients.Results: The surgical mortality rate was 0%. Sixteen major complications were recorded in 15/1300 (1.2%) patients. The complications were neurological deterioration in four patients, postoperative hematoma in two, dural lesions with cerebrospinal fluid leakage in one, deep surgical-site infection in one, persistent hoarseness in three, and persistent dysphagia in five. The two potentially life-threatening hematomas were detected within the planned six-hour observation period. Two (0.2%) patients were admitted to hospital within hours of surgery completion with stroke-like signs and symptoms, and four (0.3%) patients were admitted to hospital within 90 days due to surgery-related events. The rate of reoperations for cervical radiculopathy within 12 months was 25/1171 (2%); eight patients' reoperations were due to inadequate primary decompression, one was due to recurrent disc herniation at the same level and side, and 16 were due to new-onset radiculopathy from an adjacent level or other side.Conclusions: Outpatient microsurgical decompression of the degenerative cervical spine in carefully selected patients appears to be safe and carries a low major complication rate, low hospital admission rate, and low one-year reoperation rate.

Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe

BACKGROUND:

There is an increasing demand for surgery of degenerative spinal disease. Limited healthcare resources draw attention to the need for cost-effective treatments. Outpatient surgery, when safe and feasible, is more cost effective than inpatient surgery.

OBJECTIVE:

To study types and rates of complications after outpatient lumbar and cervical spine decompressions.

METHODS:

Complications were recorded prospectively in 1449 (1073 lumbar, 376 cervical) outpatients undergoing microsurgical decompression for degenerative spinal disease at the private Oslofjord Clinic from 2008 to 2013.

RESULTS:

Surgical mortality was 0%. A total of 51 (3.5%) minor and major complications were recorded in 51 patients. Three (0.2%) patients had to be admitted to a hospital the day of surgery. Twenty-two (1.5%) patients were admitted to a hospital within 3 months due to surgery-related events. The encountered complications were postoperative hematoma (0.6%), neurological deterioration (0.3%), deep wound infection (0.9%), dural lesions with cerebrospinal fluid leakage (1.0%), persistent dysphagia (0.1%), persistent hoarseness (0.1%), and severe pain/headache (0.4%). All of the life-threatening hematomas were detected within 6 and 3 hours after cervical and lumbar surgery, respectively.

CONCLUSION:

This series of 1449 consecutive outpatient microsurgical spine decompressions adds to the growing literature in favor of outpatient spinal surgery in properly selected patients. In our study, 99.8% of the patients were successfully discharged either to their homes or to a hotel on the day of surgery. The overall complication rate was 3.5%, surgical mortality was 0%, and only 1.5% had to be admitted to a hospital within 3 months after surgery.