Ratliff John K, Lebude Bryan, Albert Todd, Anene-Maidoh Tony, Anderson Greg, Dagostino Phillip, Maltenfort Mitchel, Hilibrand Alan, Sharan Ashwini, Vaccaro Alexander R
Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
J Neurosurg Spine. 2009 Jun;10(6):578-84. doi: 10.3171/2009.2.SPINE0935.
Definitions of complications in spinal surgery are not clear. Therefore, the authors assessed a group of practicing spine surgeons and, through the surgeons' responses to an online and emailed survey, developed a simple definition of operative complications due to spinal surgery. To validate this assessment, the authors revised their survey to make it appropriate for a lay audience and repeated the assessment with a cohort of patients who underwent spine surgery.
The authors surveyed a cohort of practicing spine surgeons via email and a web-based survey. Surgeons were presented with various complication scenarios and were asked to grade the presence or absence of a complication as well as complication severity, with responses limited to "major complication" and "minor complication/adverse event." The authors administered a similar assessment, modified for lay persons, to patients in a spinal surgery clinic.
Complete responses were obtained from 229 surgeons; orthopedic surgeons comprised the majority of respondents (73%). The authors obtained completed surveys from 197 patients. Overall, there was consistent agreement between physicians and patients regarding the presence or absence of a complication in the majority of scenarios (8 [73%] of 11 scenarios with agreement that a complication was present). The overall kappa value, evaluating major versus minor complication, and presence or absence of a complication over the entire cohort, was fair (kappa = 0.21). The authors found greater variation between the cohorts when evaluating complication severity. Patients were consistently more critical than physicians in the majority of scenarios in which a difference was evident. In 4 scenarios, patients were more likely than surgeons to deem the scenario a complication and to grade the complication as major versus minor (p < 0.01). In 3 additional scenarios, patients were more likely than physicians to grade a major complication as opposed to minor complication (p < 0.01). In only 1 scenario were patients less likely than physicians to report a complication (p < 0.001).
Comparing responses of spine surgeons and patients who underwent spinal surgery in assessing a group of common postoperative events, the authors found significant agreement on perception of presence of a complication in the majority of scenarios reviewed. However, patients were consistently more critical than surgeons when differences in reporting were found. The authors' data underscore the importance of reconciling differing opinions regarding complications through open discussions between physicians and patients to ensure accurate patient expectations of planned medical or surgical interventions.
脊柱手术并发症的定义尚不明确。因此，作者对一组脊柱外科医生进行了评估，并通过医生对在线和电子邮件调查的回复，制定了一个关于脊柱手术所致手术并发症的简单定义。为验证这一评估，作者对调查进行了修订，使其适用于普通人群，并对一组接受脊柱手术的患者重复了评估。
作者通过电子邮件和基于网络的调查对一组脊柱外科医生进行了调查。向外科医生展示了各种并发症情况，并要求他们对并发症的有无以及并发症的严重程度进行分级，回答限于“严重并发症”和“轻微并发症/不良事件”。作者对脊柱外科诊所的患者进行了类似的评估，但针对普通人群进行了修改。
获得了229名外科医生的完整回复；骨科医生占受访者的大多数（73%）。作者从197名患者那里获得了完整的调查问卷。总体而言，在大多数情况下（11种情况中有8种[73%]一致认为存在并发症），医生和患者在并发症的有无方面意见一致。评估整个队列中严重并发症与轻微并发症以及并发症的有无时，总体kappa值为中等（kappa = 0.21）。作者发现，在评估并发症严重程度时，不同队列之间的差异更大。在大多数明显存在差异的情况下，患者始终比医生更严格。在4种情况下，患者比外科医生更有可能将该情况视为并发症，并将并发症评为严重而非轻微（p < 0.01）。在另外3种情况下，患者比医生更有可能将并发症评为严重而非轻微（p < 0.01）。只有1种情况下，患者比医生报告并发症的可能性更小（p < 0.001）。
在评估一组常见的术后事件时，比较脊柱外科医生和接受脊柱手术患者的回复，作者发现在大多数审查的情况下，对于并发症存在的认知有显著的一致性。然而，当发现报告存在差异时，患者始终比外科医生更严格。作者的数据强调了通过医生与患者之间的公开讨论来调和关于并发症的不同意见的重要性，以确保患者对计划的医疗或手术干预有准确的预期。
