PMID- 33887774 OWN - NLM STAT- MEDLINE DCOM- 20211125 LR - 20211125 IS - 1524-4040 (Electronic) IS - 0148-396X (Linking) VI - 89 IP - 2 DP - 2021 Jul 15 TI - Adverse Events in Neurosurgery: The Novel Therapy-Disability-Neurology Grade. PG - 236-245 LID - 10.1093/neuros/nyab121 [doi] AB - 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. CI - (c) Congress of Neurological Surgeons 2021. FAU - Terrapon, Alexis Paul Romain AU - Terrapon APR AUID- ORCID: 0000-0003-3721-7484 AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. AD - Department of Neurosurgery, Kantonsspital St. Gallen and Medical School St. Gallen, St. Gallen, Switzerland. FAU - Zattra, Costanza Maria AU - Zattra CM AUID- ORCID: 0000-0003-0061-6553 AD - Department of Neurosurge, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. FAU - Voglis, Stefanos AU - Voglis S AUID- ORCID: 0000-0002-1514-1442 AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Velz, Julia AU - Velz J AUID- ORCID: 0000-0001-8027-9918 AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Vasella, Flavio AU - Vasella F AUID- ORCID: 0000-0002-8953-0862 AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Akeret, Kevin AU - Akeret K AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Held, Ulrike AU - Held U AUID- ORCID: 0000-0003-3105-5840 AD - Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. FAU - Schiavolin, Silvia AU - Schiavolin S AUID- ORCID: 0000-0002-5391-7539 AD - Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy. FAU - Bozinov, Oliver AU - Bozinov O AUID- ORCID: 0000-0002-4620-3992 AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. AD - Department of Neurosurgery, Kantonsspital St. Gallen and Medical School St. Gallen, St. Gallen, Switzerland. FAU - Ferroli, Paolo AU - Ferroli P AUID- ORCID: 0000-0002-8744-8857 AD - Department of Neurosurge, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. FAU - Broggi, Morgan AU - Broggi M AUID- ORCID: 0000-0001-8818-1317 AD - Department of Neurosurge, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. FAU - Sarnthein, Johannes AU - Sarnthein J AUID- ORCID: 0000-0001-9141-381X AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Regli, Luca AU - Regli L AUID- ORCID: 0000-0003-4639-4474 AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Neidert, Marian Christoph AU - Neidert MC AUID- ORCID: 0000-0003-2828-4706 AD - Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. AD - Department of Neurosurgery, Kantonsspital St. Gallen and Medical School St. Gallen, St. Gallen, Switzerland. LA - eng PT - Journal Article PT - Observational Study PL - United States TA - Neurosurgery JT - Neurosurgery JID - 7802914 SB - IM MH - Humans MH - Karnofsky Performance Status MH - *Neurology MH - *Neurosurgery MH - Neurosurgical Procedures/adverse effects MH - Retrospective Studies OTO - NOTNLM OT - CDG OT - Classification OT - Clavien-Dindo grading system OT - Grading OT - Landriel Ibanez classification OT - New neurological deficit OT - Therapy-based complication grading EDAT- 2021/04/23 06:00 MHDA- 2021/11/26 06:00 CRDT- 2021/04/22 20:33 PHST- 2020/11/24 00:00 [received] PHST- 2021/02/14 00:00 [accepted] PHST- 2021/04/23 06:00 [pubmed] PHST- 2021/11/26 06:00 [medline] PHST- 2021/04/22 20:33 [entrez] AID - 6246764 [pii] AID - 10.1093/neuros/nyab121 [doi] PST - ppublish SO - Neurosurgery. 2021 Jul 15;89(2):236-245. doi: 10.1093/neuros/nyab121.