title: The Impact of Neurosurgical Complications on Patients' Health Status: A Comparison Between Different Grades of Complications.
abstract: OBJECTIVE
  The aim of this article is to investigate the frequency of neurosurgical complications according to Landriel-Ibañez Classification and their impact on patients' health status.
  
  
  METHODS
  Patients undergoing neurosurgical procedures were enrolled in an observational longitudinal study at Neurological Institute Carlo Besta from January 2012 to September 2013. We evaluated patients' health status before surgery, at discharge, and follow-up with the Karnofsky Performance Status Scale (KPS), whereas the Landriel-Ibañez Classification was used to record complications. Descriptive statistics were performed to illustrate the distribution of sociodemographic and clinical data. We used nonparametric tests to compare KPS scores of patients with different grades of complication and to evaluate the differences between preoperative KPS scores, KPS scores at discharge and follow-up. The effect sizes were also calculated.
  
  
  RESULTS
  We enrolled 1008 patients. We registered 228 complications (139 grade 1 complications, 63 grade 2 complications, 20 grade 3 complications, and 6 grade 4 complications). All patients with a complication showed KPS scores at discharge that were lower than preoperative scores and KPS scores at follow-up greater than scores at discharge. After patients with grade 4 complications, who had the worst outcomes, those with grade 3 complications were the most compromised after surgery whereas patients with grade 2 complications seemed to have a better health status than patients with grade 1 complication.
  
  
  CONCLUSIONS
  Our study highlights the impact of neurosurgical complications on patients' life and contributes to the debate on how define and classify adverse events because a classification only based on treatment seems to be not adequate.
authors.affiliation: Neurology, Public Health, and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy. Electronic address: silvia.schiavolin@istituto-besta.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schiavolin
authors.affiliation: Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Morgan
authors.initials: M
authors.lastname: Broggi
authors.affiliation: Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Acerbi
authors.affiliation: Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Brock
authors.affiliation: Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Schiariti
authors.affiliation: Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cusin
authors.affiliation: Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Visintini
authors.affiliation: Neurology, Public Health, and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
authors.affiliation: Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferroli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002493:Central Nervous System Diseases / Q000601:surgery*; D016543:Central Nervous System Neoplasms / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D017567:Karnofsky Performance Status; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D012720:Severity of Illness Index
keywords: Classification; Health status; KPS; Neurosurgical complications