title: Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery.
abstract: OBJECTIVE
  Definitions of complications in spinal surgery are not clear. Therefore, the authors assessed a group of practicing spine surgeons and, through the surgeons' responses to an online and emailed survey, developed a simple definition of operative complications due to spinal surgery. To validate this assessment, the authors revised their survey to make it appropriate for a lay audience and repeated the assessment with a cohort of patients who underwent spine surgery.
  
  
  METHODS
  The authors surveyed a cohort of practicing spine surgeons via email and a web-based survey. Surgeons were presented with various complication scenarios and were asked to grade the presence or absence of a complication as well as complication severity, with responses limited to "major complication" and "minor complication/adverse event." The authors administered a similar assessment, modified for lay persons, to patients in a spinal surgery clinic.
  
  
  RESULTS
  Complete responses were obtained from 229 surgeons; orthopedic surgeons comprised the majority of respondents (73%). The authors obtained completed surveys from 197 patients. Overall, there was consistent agreement between physicians and patients regarding the presence or absence of a complication in the majority of scenarios (8 [73%] of 11 scenarios with agreement that a complication was present). The overall kappa value, evaluating major versus minor complication, and presence or absence of a complication over the entire cohort, was fair (kappa = 0.21). The authors found greater variation between the cohorts when evaluating complication severity. Patients were consistently more critical than physicians in the majority of scenarios in which a difference was evident. In 4 scenarios, patients were more likely than surgeons to deem the scenario a complication and to grade the complication as major versus minor (p < 0.01). In 3 additional scenarios, patients were more likely than physicians to grade a major complication as opposed to minor complication (p < 0.01). In only 1 scenario were patients less likely than physicians to report a complication (p < 0.001).
  
  
  CONCLUSIONS
  Comparing responses of spine surgeons and patients who underwent spinal surgery in assessing a group of common postoperative events, the authors found significant agreement on perception of presence of a complication in the majority of scenarios reviewed. However, patients were consistently more critical than surgeons when differences in reporting were found. The authors' data underscore the importance of reconciling differing opinions regarding complications through open discussions between physicians and patients to ensure accurate patient expectations of planned medical or surgical interventions.
authors: Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. john.ratliff@jefferson.edu
authors: John K
authors: JK
authors: Ratliff
authors: Bryan
authors: B
authors: Lebude
authors: Todd
authors: T
authors: Albert
authors: Tony
authors: T
authors: Anene-Maidoh
authors: Greg
authors: G
authors: Anderson
authors: Phillip
authors: P
authors: Dagostino
authors: Mitchel
authors: M
authors: Maltenfort
authors: Alan
authors: A
authors: Hilibrand
authors: Ashwini
authors: A
authors: Sharan
authors: Alexander R
authors: AR
authors: Vaccaro
mesh_terms: D015331:Cohort Studies; D013502:General Surgery / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007796:Laminectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011183:Postoperative Complications / Q000453:epidemiology*; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome