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Defining “Complications” in Spine Surgery: Neurosurgery and Orthopedic Spine Surgeons' Survey

Lebude, Bryan BA*; Yadla, Sanjay MD; Albert, Todd MD; Anderson, David G. MD; Harrop, James S. MD; Hilibrand, Alan MD; Maltenfort, Mitchel PhD; Sharan, Ashwini MD; Vaccaro, Alexander R. MD, PhD; Ratliff, John K. MD

Journal of Spinal Disorders & Techniques: December 2010 - Volume 23 - Issue 8 - p 493–500
doi: 10.1097/BSD.0b013e3181c11f89
Original Articles

Study Design Survey of neurosurgical and orthopedic spine surgeons.

Objective To define the “complications of spinal surgery,” we surveyed a large group of practicing spine surgeons to establish a preliminary definition of perioperative complications.

Summary of Background Data Although the risk of complications following spinal procedures plays an important role in determining the appropriateness of surgical intervention, there is little consensus among spine surgeons regarding the definition of complications in spine surgery. The relevance of medical complications is also not clearly defined.

Methods We surveyed a cohort of practicing spine surgeons via email and a commercially maintained website. Surgeons were presented with various complication scenarios, and asked to assess the presence or absence of a complication, as well as complication severity, with responses limited to “major complication” and “minor complication/adverse event.”

Results The survey was sent to approximately 2000 practicing surgeons; complete responses were received from 229, giving a response rate of 11.4%. Orthopedic surgeons comprised the majority of respondents (73%); most surgeons reported being in practice for greater than 5 years (83%). Greater than 75% of surgeons agreed on complication presence or absence in 10 of 11 scenarios assessed (91%, P<0.05). Consensus (≥70% agreement, P<0.05) as to type of complication was found in 7 of 11 scenarios presented (64%). Events deemed major complications involved either severe medical adverse events with permanent sequela or events requiring return to the operating room. Surgeons consistently considered medical adverse events, whether or not directly related to surgery, relevant to complication assessment.

Conclusions We present a practical binary definition of complications in spine surgery based upon a survey of over 200 practicing spine surgeons. Further work is required in critically assessing spine surgery complications.

*Jefferson Medical College

Departments of Neurosurgery

Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA assisted this study via posting a survey upon their website. No financial support relevant to this study was received by the investigators from

Reprints: John K. Ratliff, MD, Department of Neurosurgery, Thomas Jefferson University, 909 Walnut 2nd Flr, Philadelphia, PA 19107 (e-mail:

Received April 12, 2009

Accepted August 31, 2009

© 2010 Lippincott Williams & Wilkins, Inc.