A New Classification System to Report Complications in Growing Spine Surgery: A Multicenter Consensus Study John T. Smith, MD, Charles Johnston,

Slides:

Advertisements

Similar presentations

1 Bridging Terminology and Classification Gaps among Patient Safety Information Systems Andrew Chang, JD, MPH, Laurie Griesinger, MPH, Peter Pronovost,

Advertisements

Dr. ABDULLAH ABDU ALMIKHLAFY Assistant professor & Head of community medicine department Presented By University of Science & Technology Sana’a – Yemen.

The Nature of Errors Richard M. Satava, MD FACS Professor of Surgery University of Washington School of Medicine and Program Manager, Advanced Biomedical.

Two Wrongs Don't Make a Right (Kidney)

InFUSE ™ Bone Graft / LT-CAGE ™ Lumbar Tapered Fusion Device IDE Clinical Results G Hallett H. Mathews, M.D. Richmond, Virginia.

Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients Assessment.

Diagnosing Mental Disorders- The Multiaxial Approach

Research Design ED 592A Fall Research Concepts 1. Quantitative vs. Qualitative & Mixed Methods 2. Sampling 3. Instrumentation 4. Validity and Reliability.

Thoracogenic Spinal Deformity: A Rare Cause of Early Onset Scoliosis International Congress on Early Onset Scoliosis November 19 & 20, 2015 A. Noelle Larson,

Growth Preserving Spinal Surgery for Scoliosis in Children with Osteogenesis Imperfecta Lawrence Karlin, MD, Amer Samdani, MD, Anna McClung, BSN, RN, Michael.

Comparison of deformity correction and complications with VEPTR and early primary posterior spinal fusion in young children with idiopathic scoliosis:

Short Term Health Related Quality of Life and Family Burden after Surgical or Casting Treatment Hiroko Matsumoto, Nicholas Feinberg, Julie Yoshimachi,

Intra-wound Vancomycin Powder Significantly Reduces the Risk of Infection in Growth-friendly Surgery John T. Smith, MD Justin Haller, MD Angela Presson,

John T. Wilkinson m. d. , Chad E. Songy m. d. , Frances l

Final Fusion in Patients Treated with Rib Based Distraction: A Review of Peri- operative Results THE UNIVERSITY OF UTAH Department of Orthopaedic Surgery.

Burt Yaszay, MD Jeff B. Pawelek, BS John Emans, MD Patrick Cahill, MD Bo Robertson Gregory M. Mundis, MD Behrooz A. Akbarnia, MD Children’s Spine Study.

The National Burden of Revision Spinal Fusion: A Focus on Patient Characteristics and Complications Sean S. Rajaee MS Linda E. A. Kanim MA Hyun W. Bae.

Russian Academy of Medical Science Moskow June

Problem Statements-Questions n The problem dictates the design ******** n What is experience of police officers who were wounded in the line of duty related.

Department of Defense Trauma Registry (DODTR) Description

Swamy Kurra Stephen Albanese Patrick Cahill Randal Betz

Adam Margalit, BS Paul D. Sponseller, MD Richard McCarthy, MD

ICEOS 2016 Utrecht, November 2016

ICEOS 2016 Comparison of Weight Percentile Gain with Growth-Friendly Constructs in Early Onset Scoliosis Liam Harris BS1, Lindsay M Andras MD1, Paul D.

VEPTR Implantation for Children with congenital scoliosis under Age 3

Assessing and Improving the Quality of Care For Low Back Pain

Sumeet Garg, MD Jack Flynn, MD Nicole Michael, BA

Growth Friendly Surgery is Effective at Treating Scoliosis Associated with Goldenhar Syndrome Braydon Connell, Jonathan Oore, Joshua Pahys, George Thompson,

Nicole Michael, BA John Smith, MD Tricia St. Hilaire, MPH

Results of Growth Friendly Surgery Versus Casting for the Treatment of EOS in Patients with Prader-Willi Syndrome Jonathan Oore, Braydon Connell, Burt.

John T. Smith, MD Jessica V. Morgan John A. Heflin, MD

Martha Carvour, MD, PhD March 2, 2017

Children’s National Health System ICEOS 2016 – Utrecht, Holland

Correlation of developmental outcome with severity of bronchopulmonary dysplasia in extremely low gestational age neonates Karen Belen, Chengqiu Lu, Narges.

How Often do you Lengthen

Menachem M Meller,MD, PhD

PELVIC OBLIQUITY CONTROL IN CHILDREN WITH NEUROMUSCULAR EARLY ONSET SCOLIOSIS TREATED WITH MAGNETICALLY-CONTROLLED GROWING RODS María del Mar Pozo-Balado,

John T. Smith, MD Jessica V. Morgan John A. Heflin, MD

Distraction-Based Surgeries Increase Spine Length for Patients with Non-Idiopathic EOS - 5 Year Follow up Yehia ElBromboly, Jennifer Hurry, Kedar Padhye,

The Use of MAGEC Growing Rods as a temporary distraction rod in Severe Kyphoscoliosis: 2 Case Reports. John T. Smith, MD Mary Scowcroft Perry Presidential.

Jimmy Nguyen and Paul Arnold, M.D.

Results of corrective surgery: secondary lens implantation at a cataract surgery training centre Mehul Shah,shreya shah, adway appalware,pramod upadhyay,

Hospital Universitario La Paz, Madrid, Spain

Hallett H. Mathews, M.D. Richmond, Virginia

Does rod orientation and use of cross connector affect spinal height in magnetically controlled growing rod patients? Pooria Hosseini, Behrooz A. Akbarnia,

E-Poster 159 VEPTR Implantation to Treat Children with Early Onset Scoliosis without Rib Abnormalities: A Prospective Multicenter Study Ron El-Hawary,

Evaluation of Pulse Oximetry in Pre- and Post Casting

Good morning, ladies and gentlemen. Please let me introduce myself

TELEMEDICINE PROJECT IN MONTENEGRO

Magnetically Controlled Growing Rods: Sagittal Plane Analysis and the Risk of Proximal Junctional Kyphosis Purnendu Gupta, Felix Brassard, Jennifer Schottler,

Dan Perry, MD (Presented by Jennifer Laine, MD)

I-Chan Lin MD, Paul P. Lee MD, JD

Analysis of Percentile Weight Changes in Failure To Thrive Children undergoing Growing Rod Insertion. ICEOS 2012 Walsh A, Lui DF, Kelly M, O'Neill F, McDevitt.

Can Infection Associated with Rib Distraction Instrumentation be Managed without Implant Removal? A Multi-Center Study John T. Smith, MD* Patrick Cahill,

Sara K. Fuhrhop, BS Mark J. McElroy, MS Harry C. Dietz, MD

Dual Rods and Submuscular Rod Placement Reduce Complications and Unplanned Surgeries in the Growing Spine: Analysis of 910 Surgeries in 143 Patients Shay.

Is Vertical Expandable Prosthetic Titanium Rib (VEPTR) Application a Sufficient Method to Provide Expected Spinal Growth in Congenital Scoliosis? M. Bulent.

John A Heflin, MD John T. Smith, MD

Classification of EOS Treatment

Sumeet Garg, MD The Children’s Hospital, Colorado

Pulmonary Outcomes after VEPTR Intervention

Nicholas D. Fletcher, MD¹ Charles E. Johnston III, MD²

Is fusion surgery always the end point?

Scoliosis surgery with hybrid system in osteogenesis imperfecta (OI)

The Psychosocial Impact

The Classification for Early-Onset Scoliosis (C-EOS) Predicts Timing of VEPTR Anchor Failure Michael G. Vitale, MD MPH Associate Chief, Division of.

Amer F. Samdani, MD Tricia St. Hilaire John Emans, MD John Smith, MD

Simultaneous Vertebral Column Resection (VCR) and Growing Rods (GR) or Shilla for Severe Early Onset Spinal Deformity (EOS) John Emans, MD; Ashley Goldthwait,

Management of Implant Related Infections:

Presentation transcript:

A New Classification System to Report Complications in Growing Spine Surgery: A Multicenter Consensus Study John T. Smith, MD, Charles Johnston, MD, David Skaggs, MD, John Flynn, MD, Michael Vitale, MD A joint effort of the CWSDSG and GSSG

Disclosures Consultant: Depuy-Synthes spine Royalties: VEPTR 2 device Board Member: CWSDRF Study supported by a grant from OREF

Complications in growing spine surgery Common Variable consequences on the course of care Lack a standardized reporting system Difficult to compare results

Purpose Develop consensus for a new classification system for reporting complications in growing spine surgery Pilot study to evaluate ‘ease of use’ of the system

Methods Phase 1: Consensus meeting to develop standardized classification for reporting complications* Phase 2: Test system on 10 patients from 5 centers for ease of use OREF Grant, 2011*

Definitions Complication: An unexpected medical event in the course of treatment that may or may not affect final outcome. Severity: Severity refers to the level of care and urgency the required to treat a patient’s complication. Device related complication: A complication that occurred as a direct result of a patient’s device. To determine if the complication is device related, ask the following question: “If the patient did not have the device, would the complication occur?” Disease related complication: Complications which are not directly related to the growing spine device.

Categories of Complications Related to Growing Spine Surgery Device Related Disease Related

Severity Scores for Device Related Complications Severity Grade I: A complication that does not require an unplanned return to the operating room and can be corrected at the next planned surgery. Severity Grade II: A complication that requires an unplanned return to the operating room. IIA: Requires a single trip to the operating room. IIB: Requires multiple trips to the operating room (example, multiple I& D’s for a persistent infection.) Severity Grade III: A complication that alters the planned course of treatment.

Severity Scores for Disease Related Complications Grade I: A complication that does not require hospitalization and can be treated on an out patient basis. Grade II: A complication that requires hospitalization Grade III: A complication that alters the planned course of treatment.

Results 65 patients (5 institutions) 56 pts had at lease 1 complication; 9 with none Diagnosis: varied VEPTR:46; Growing Rods:14; Hybrids:4. Average Age: 4.7 yrs Minimum follow-up: 2 years Total surgical events: 423

Average procedures per patient Expansions: 5.3 Revisions: 1.7 Exchanges: 0.6

Complications: 181 Migration: 60 Infection: 31 Pneumonia: 21 Instrumentation failure: 23 Other: 46

What does that mean? Complication rate = 400%? Complications per procedure = 42%? Average complication per patient = 2.8?

Overall Complications when classified: Grade I: (57) Grade IIA (95) Grade IIB (10) Grade III (6)

Disease Related Complications Severity number I 4 II 15 III 1 Device Related Complications Severity number I 53 IIA 80 IIB 10 III 5

Conclusions Complications are common in growing spine surgery, but…. Only 9% of patients in this pilot study had an event significant enough to alter their plan of care. (ie: Grade III)

Conclusions Complications are expected in growing spine surgery….. Classification was easy to use Provides meaningful information regarding the impact of an adverse event on the overall plan of care Allows for comparison of different techniques

Thank you