A New Classification of Complications in Neurosurgery
A New Classification of Complications in Neurosurgery
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DOI：
10.1016/j.wneu.2010.11.010
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发表时间：
2011-05-01
影响因子：
2
通讯作者：
Carrizo, Antonio
中科院分区：
文献类型：
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作者：
Landriel Ibanez, Federico Alfonso;Hem, Santiago;Carrizo, Antonio
目的：根据治疗需要对神经外科和脊柱术后并发症进行定义和分级。方法：并发症定义为手术后 30 天内发生的任何偏离正常术后过程的情况。根据用于治疗并发症的疗法提出了四级量表：I级，任何非危及生命的并发症，无需侵入性手术治疗； II级，需要侵入性治疗的并发症，例如手术、内窥镜和血管内手术； III级，危及生命的不良事件，需要在重症监护室（ICU）治疗； IV级，因并发症而死亡。每个等级都被归类为手术或医疗并发症。 2008 年 1 月至 2009 年 12 月期间，在布宜诺斯艾利斯意大利医院的 1190 名患者队列中对该系统进行了观察性测试。 结果：在 167 例并发症中，129 例 (10.84%) 属于手术并发症，38 例 (3.19%) 属于内科并发症。 Ⅰ级（轻度）并发症占31.73%，Ⅱ级（中度）并发症占25.74%，Ⅲ级（重度）并发症占34.13%。总死亡率为1.17%； 0.84% 的死亡与外科手术直接相关。结论：作者提出了一种简单、实用且易于重现的方法，用于根据治疗并发症的疗法来报告负面结果。这种分类的主要优点是能够比较不同中心和时间之间的手术结果、比较医疗和手术并发症的能力以及进行未来荟萃分析的能力。
OBJECTIVE: To define and grade neurosurgical and spinal postoperative complications based on their need for treatment.METHODS: Complications were defined as any deviation from the normal postoperative course occurring within 30 days of surgery. A four-grade scale was proposed based on the therapy used to treat the complications: grade I, any non-life-threatening complications treated without invasive procedures; grade II, complications requiring invasive management such as surgical, endoscopic, and endovascular procedures; grade III, life-threatening adverse events requiring treatment in an intensive care unit (ICU); and grade IV, deaths as a result of complications. Each grade was classified as a surgical or medical complication. An observational test of this system was conducted between January 2008 and December 2009 in a cohort of 1190 patients at the Hospital Italiano de Buenos Aires.RESULTS: Of 167 complications, 129 (10.84%) were classified as surgical, and 38 (3.19%) were classified as medical complications. Grade I (mild) complications accounted for 31.73%, grade II (moderate) complications accounted for 25.74%, and grade III (severe) complications accounted for 34.13%. The overall mortality rate was 1.17%; 0.84% of deaths were directly related to surgical procedures.CONCLUSIONS: The authors present a simple, practical, and easy to reproduce way to report negative outcomes based on the therapy administered to treat a complication. The main advantages of this classification are the ability to compare surgical results among different centers and times, the ability to compare medical and surgical complications, and the ability to perform future meta-analyses.