Publication

Adverse Events in Neurosurgery: The Novel Therapy-Disability-Neurology Grade

Journal Paper/Review - Apr 22, 2021

Units
Keywords
CDG, Clavien-Dindo grading system, Classification, Grading, Landriel IbaƱez classification, New neurological deficit, Therapy-based complication grading
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Citation
Terrapon A. Adverse Events in Neurosurgery: The Novel Therapy-Disability-Neurology Grade. Neurosurgery 2021
Project
Type
Journal Paper/Review (English)
Journal
Neurosurgery 2021
Publication Date
Apr 22, 2021
Issn Print
Issn Electronic
Pages
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Brief description/objective

BACKGROUND
The most widely used classifications of adverse events (AEs) in neurosurgery define their severity according to the therapy used to treat them. This concept has substantial shortcomings because it does not reflect the severity of AEs that are not treated, such as new neurological deficits.

OBJECTIVE
To present a novel multidimensional and patient-centered classification of the severity of AE in neurosurgery and evaluate its applicability.

METHODS
The Therapy-Disability-Neurology (TDN) grading system classifies AEs depending on the associated therapy, disability, and neurological deficits. We conducted a 2-center retrospective observational study on 6071 interventions covering the whole neurosurgical spectrum with data prospectively recorded between 2013 and 2019 at 2 institutions from 2 countries.

RESULTS
Using the first patient cohort (4680 interventions), a positive correlation was found between severity of AE and LOS as well as treatment cost. Each grade was associated with a greater deterioration of the Karnofsky Performance Status Scale (KPS) at discharge and at follow-up. When using the same methods on the external validation cohort (1391 interventions), correlations between the grades of AE, LOS, and KPS at discharge were even more pronounced.

CONCLUSION
Our results suggest that the TDN grade is consistent with clinical and economic repercussions of AE and thus reflects AE severity. It is easily interpreted and enables comparison between different medical centers. The standardized report of the severity of AE in the scientific literature could constitute an important step forward toward a more critical, patient-centered, and evidence-based decision-making in neurosurgery.