- Email: [email protected]
A Simple Neurosurgery Complications Classification System Is Needed
Perspectives Commentary on: A New Classification of Complications in Neurosurgery by Ibañez et al. pp. 709-715.
Jizong Zhao, M.D. President, Chinese Neurosurgical Society Professor and Chairman, Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University
A Simple Neurosurgery Complications Classification System Is Needed Jizong Zhao
A
neurosurgery complications classification system can be used to assess treatment effect and outcome. In the clinic, no gold standard for neurosurgery complications classification is accepted worldwide until now. In his article, Dr. Landriel presented a new, detailed classification of complications in neurosurgery based on his extensive experience at the Hospital Italiano de Buenos Aires in Argentina. He tested this classification system with a cohort of 1190 patients who underwent neurosurgery at his institution and finally proved that this classification system was a simple, practical, and easy-to-reproduce way to report negative outcomes. It is certainly a well-done study. Actually, in 1992, Clavein and his colleagues from Switzerland had already reported a similar surgical complication classification system (2). They proposed a classification of complications based on four grades: Grade I complications were alterations from the ideal postoperative course, non-life-threatening, and with no lasting disability. Complications of this grade necessitated only bedside procedures and did not significantly extend hospital stay. Grade II complications were potentially life-threatening but without residual disability. Within Grade II complications, a subdivision was made according to the requirement for invasive procedures. Grade III complications were those with residual disability, including organ resection or persistence of life-threatening conditions. Grade IV complications are deaths as a result of complications. In 2004, they further developed the grading system into a five-scale classification system and supplemented two subgroups for Grades III and IV (3). Compared with the 1992 system, they eliminated hospital stay as a criterion and increased the weight of life-threatening com-
Key words 䡲 Adverse outcome 䡲 Morbidity and mortality conference 䡲 Neurosurgical complications 䡲 Spine complications
610
www.SCIENCEDIRECT.com
plications involving organ failure. After being modified, the system was widely accepted and further validated through a large cohort of patients, who underwent a variety of surgical procedures. In 2009, Clavein et al. systematically evaluated this classification system based on the literature from those 5 years and the experience from 10 centers from different continents where the classification system was routinely used; they concluded that the classification was valid and applicable worldwide in many fields of surgery (1). As one of the participants in the 10 centers, the investigator in this study, Dr. Landriel, created the neurosurgery complications classification system based on Clavein’s system and their clinical experience in neurosurgery. It is very similar to Clavein’s, and the only difference is that Dr. Landriel further classified grading into medical or surgical complications, which can help us identify whether adverse events are directly related to surgery or something else. In my personal opinion, I doubt if it is necessary. In general, there are two important factors to decide if a classification system can be widely accepted and used: one is broad coverage, the other is simplicity. The other well-known grading systems such as the Hunt and Hess scale, House–Brackmann facial paralysis scale, Glasgow Outcome Scale, and so on are all very simple. Although Dr. Landriel’s classification is more detailed, with complications further divided into surgery and medical, it also affects its simplicity. On the condition of not affecting its coverage, the simpler, the better. Anyway, Dr. Landriel has provided us an objective, reproducible complications classification of neurosurgery. To my knowledge, it is the best classification system in neurosurgery until now, although it still needs to be tested and developed.
From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China To whom correspondence should be addressed: Jizong Zhao, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2011) 75, 5/6:610-611. DOI: 10.1016/j.wneu.2010.12.037
WORLD NEUROSURGERY, DOI:10.1016/j.wneu.2010.12.037
PERSPECTIVES
REFERENCES 1. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M: The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187-196, 2009.
2. Clavien PA, Sanabria JR, Strasberg SM: Proposed classifications of surgery with examples of utility in cholecystectomy. Surgery 111:518-526, 1992.
Citation: World Neurosurg. (2011) 75, 5/6:610-611. DOI: 10.1016/j.wneu.2010.12.037
3. Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results or a survey. Ann Surg 240:205-213, 2004.
Available online: www.sciencedirect.com
WORLD NEUROSURGERY 75 [5/6]: 610-611, MAY/JUNE 2011
Journal homepage: www.WORLDNEUROSURGERY.org
1878-8750/$ - see front matter © 2011 Elsevier Inc. All rights reserved.
www.WORLDNEUROSURGERY.org
611
Jizong Zhao, M.D. President, Chinese Neurosurgical Society Professor and Chairman, Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University
A Simple Neurosurgery Complications Classification System Is Needed Jizong Zhao
A
neurosurgery complications classification system can be used to assess treatment effect and outcome. In the clinic, no gold standard for neurosurgery complications classification is accepted worldwide until now. In his article, Dr. Landriel presented a new, detailed classification of complications in neurosurgery based on his extensive experience at the Hospital Italiano de Buenos Aires in Argentina. He tested this classification system with a cohort of 1190 patients who underwent neurosurgery at his institution and finally proved that this classification system was a simple, practical, and easy-to-reproduce way to report negative outcomes. It is certainly a well-done study. Actually, in 1992, Clavein and his colleagues from Switzerland had already reported a similar surgical complication classification system (2). They proposed a classification of complications based on four grades: Grade I complications were alterations from the ideal postoperative course, non-life-threatening, and with no lasting disability. Complications of this grade necessitated only bedside procedures and did not significantly extend hospital stay. Grade II complications were potentially life-threatening but without residual disability. Within Grade II complications, a subdivision was made according to the requirement for invasive procedures. Grade III complications were those with residual disability, including organ resection or persistence of life-threatening conditions. Grade IV complications are deaths as a result of complications. In 2004, they further developed the grading system into a five-scale classification system and supplemented two subgroups for Grades III and IV (3). Compared with the 1992 system, they eliminated hospital stay as a criterion and increased the weight of life-threatening com-
Key words 䡲 Adverse outcome 䡲 Morbidity and mortality conference 䡲 Neurosurgical complications 䡲 Spine complications
610
www.SCIENCEDIRECT.com
plications involving organ failure. After being modified, the system was widely accepted and further validated through a large cohort of patients, who underwent a variety of surgical procedures. In 2009, Clavein et al. systematically evaluated this classification system based on the literature from those 5 years and the experience from 10 centers from different continents where the classification system was routinely used; they concluded that the classification was valid and applicable worldwide in many fields of surgery (1). As one of the participants in the 10 centers, the investigator in this study, Dr. Landriel, created the neurosurgery complications classification system based on Clavein’s system and their clinical experience in neurosurgery. It is very similar to Clavein’s, and the only difference is that Dr. Landriel further classified grading into medical or surgical complications, which can help us identify whether adverse events are directly related to surgery or something else. In my personal opinion, I doubt if it is necessary. In general, there are two important factors to decide if a classification system can be widely accepted and used: one is broad coverage, the other is simplicity. The other well-known grading systems such as the Hunt and Hess scale, House–Brackmann facial paralysis scale, Glasgow Outcome Scale, and so on are all very simple. Although Dr. Landriel’s classification is more detailed, with complications further divided into surgery and medical, it also affects its simplicity. On the condition of not affecting its coverage, the simpler, the better. Anyway, Dr. Landriel has provided us an objective, reproducible complications classification of neurosurgery. To my knowledge, it is the best classification system in neurosurgery until now, although it still needs to be tested and developed.
From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China To whom correspondence should be addressed: Jizong Zhao, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2011) 75, 5/6:610-611. DOI: 10.1016/j.wneu.2010.12.037
WORLD NEUROSURGERY, DOI:10.1016/j.wneu.2010.12.037
PERSPECTIVES
REFERENCES 1. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M: The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187-196, 2009.
2. Clavien PA, Sanabria JR, Strasberg SM: Proposed classifications of surgery with examples of utility in cholecystectomy. Surgery 111:518-526, 1992.
Citation: World Neurosurg. (2011) 75, 5/6:610-611. DOI: 10.1016/j.wneu.2010.12.037
3. Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results or a survey. Ann Surg 240:205-213, 2004.
Available online: www.sciencedirect.com
WORLD NEUROSURGERY 75 [5/6]: 610-611, MAY/JUNE 2011
Journal homepage: www.WORLDNEUROSURGERY.org
1878-8750/$ - see front matter © 2011 Elsevier Inc. All rights reserved.
www.WORLDNEUROSURGERY.org
611