Gozal Yair M, Aktüre Erinç, Ravindra Vijay M, Scoville Jonathan P, Jensen Randy L, Couldwell William T, Taussky Philipp
J Neurosurg. 2019 Jan 18;132(1):272-276. doi: 10.3171/2018.9.JNS181004. Print 2020 Jan 1.
The absence of a commonly accepted standardized classification system for complication reporting confounds the recognition, objective reporting, management, and avoidance of perioperative adverse events. In the past decade, several classification systems have been proposed for use in neurosurgery, but these generally focus on tallying specific complications and grading their effect on patient morbidity. Herein, the authors propose and prospectively validate a new neurosurgical complication classification based on understanding the underlying causes of the adverse events.
A new complication classification system was devised based on the authors' previous work on morbidity in endovascular surgery. Adverse events were prospectively compiled for all neurosurgical procedures performed at their tertiary care academic medical center over the course of 1 year into 5 subgroups: 1) indication errors; 2) procedural errors; 3) technical errors; 4) judgment errors; and 5) critical events. The complications were presented at the monthly institutional Morbidity and Mortality conference where, following extensive discussion, they were assigned to one of the 5 subgroups. Additional subgroup analyses by neurosurgical subspecialty were also performed.
A total of 115 neurosurgical complications were observed and analyzed during the study period. Of these, nearly half were critical events, while technical errors accounted for approximately one-third of all complications. Within neurosurgical subspecialties, vascular neurosurgery (36.5%) had the most complications, followed by spine & peripheral nerve (21.7%), neuro-oncology (14.8%), cranial trauma (13.9%), general neurosurgery (12.2%), and functional neurosurgery (0.9%).
The authors' novel neurosurgical complication classification system was successfully implemented in a prospective manner at their high-volume tertiary medical center. By employing the well-established Morbidity and Mortality conference mechanism, this simple system may be easily applied at other neurosurgical centers and may allow for uniform analyses of perioperative morbidity and the introduction of corrective initiatives.
缺乏一个被普遍接受的并发症报告标准化分类系统，这使得围手术期不良事件的识别、客观报告、管理及避免变得混乱。在过去十年里，已有几种分类系统被提出用于神经外科，但这些系统通常侧重于统计特定并发症并对其对患者发病率的影响进行分级。在此，作者基于对不良事件潜在原因的理解，提出并前瞻性验证一种新的神经外科并发症分类方法。
基于作者先前关于血管内手术发病率的研究工作，设计了一种新的并发症分类系统。前瞻性收集了在其三级医疗学术医学中心进行的所有神经外科手术在1年期间发生的不良事件，并将其分为5个亚组：1）适应证错误；2）操作错误；3）技术错误；4）判断错误；5）危急事件。这些并发症在每月的机构发病率和死亡率会议上进行展示，经过广泛讨论后，被归入5个亚组中的一个。还进行了神经外科亚专业的额外亚组分析。
在研究期间共观察和分析了115例神经外科并发症。其中，近一半是危急事件，而技术错误约占所有并发症的三分之一。在神经外科亚专业中，血管神经外科（36.5%）的并发症最多，其次是脊柱与周围神经（21.7%）、神经肿瘤学（14.8%）、颅脑创伤（13.9%）、普通神经外科（12.2%）和功能神经外科（0.9%）。
作者的新型神经外科并发症分类系统在其高流量的三级医疗中心以前瞻性方式成功实施。通过采用成熟的发病率和死亡率会议机制，这个简单的系统可能很容易应用于其他神经外科中心，并可能允许对围手术期发病率进行统一分析以及引入纠正措施。
