Validation of a modified Clavien-Dindo Classification for postoperative complications in orthopedic surgery

Gaston Camino Willhuber; Pablo Slullitel; Danilo  Taype Zamboni; Jose Albergo; Sergio Terrasa; Nicolas Piuzzi; Jorge Boretto

doi:10.31053/1853.0605.v77.n3.27931

Autores/as

Camino Willhuber Gaston Hospital Italiano de Buenos Aires
Slullitel Pablo Hospital Italiano de Buenos Aires
Taype Zamboni Danilo Hospital Italiano de Buenos Aires
Albergo Jose Hospital Italiano de Buenos Aires
Terrasa Sergio Hospital Italiano de Buenos Aires
Piuzzi Nicolas Cleveland Clinic
Boretto Jorge Hospital Italiano de Buenos Aires

DOI:

https://doi.org/10.31053/1853.0605.v77.n3.27931

Palabras clave:

complicaciones posoperatorias, ortopedia, sistemas de salud

Resumen

Introducción: Las complicaciones postoperatorias constituyen cualquier desviación del estado postoperatorio normal. El registro de las mismas sigue siendo un desafío, se han propuesto múltiples sistemas de clasificación, sin embargo, estos no han sido validados en todas las especialidades quirúrgicas. Clavien y Dindo desarrollaron un sistema para Cirugía General y ha sido adoptado en diferentes campos. Sin embargo, esta clasificación no se ha adaptado a la ortopedia. El objetivo de este estudio fue adaptar la clasificación de Clavien-Dindo a los escenarios ortopédicos y determinar la confiabilidad intra e interobservador.

Materiales y Métodos: Se adaptó la clasificación de Clavien Dindo a los escenarios ortopédicos. Diez observadores con diferentes grados de entrenamiento y experiencia fueron seleccionados para evaluar la clasificación. Se enviaron 48 escenarios clínicos simulados de complicaciones y otros resultados negativos en formato electrónico de forma independiente. Se realizó una segunda ronda de puntuación 30 días después para evaluar la concordancia intraobservador.

Resultados: Encontramos una alta confiabilidad interobservador e intraobservador tanto para la primera como para la segunda evaluación (Kappa 0.88 y 0.91, respectivamente). Además, el análisis intraobservador mostró una muy buena correlación (Kappa 0,93).

Discusión: La clasificación Clavien-Dindo se ha desarrollado para cirugía general y se ha aplicado ampliamente en las diferentes subespecialidades quirúrgicas. En ortopedia, esta clasificación fue validada para cirugías de cadera y pediátrica. Por lo tanto, nuestro estudio implicó una adaptación de la clasificación a escenarios ortopédicos generales y específicos de las diferentes subespecialidades ortopédicas. Esta clasificación puede ser una herramienta útil para documentar complicaciones en cirugía ortopédica.

Palabras claves: complicaciones posoperatorias; ortopedia; sistema de salud

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Biografía del autor/a

Camino Willhuber Gaston , Hospital Italiano de Buenos Aires
1. Grado Academico maximo: Medico, Especialista en Ortopedia y Traumatologia
2. Medico asociado del servicio de Ortopedia y Traumatologia del Hospital Italiano de Buenos Aires
3. Publicaciones recientes:
4. Pereira-Duarte M, Camino G, Estefan M, Kido G, Solá C, Gruenberg M. Criptococosis vertebral. Comunicación de un caso y revisión bibliográfica [Vertebral cryptococosis. Case report and literature review]. Rev Chilena Infectol. 2019;36(5):656–662. doi:10.4067/S0716-10182019000500656 PMID: 31859808
5. Classification in Brief: The Spinal Deformity Study Group Classification of Lumbosacral Spondylolisthesis. Camino Willhuber G; Kido G. Clinical Orthopedics and Related Research. Oct 2019.DOI: 10.1097/CORR.0000000000001005 PMID: 31651588
6. Percutaneous Cement Discoplasty for the Treatment of Advanced Degenerative Disc Conditions: A Case Series Analysis. Camino Willhuber G., Kido G., Pereira Duarte M., Estefan M., Bendersky M., Bassani J., Petracchi M., Gruenberg M., Sola C. Global Spine J. 2019. https://doi.org/10.1177/2192568219873885
7. Letter to the Editor Regarding Anterior Lumbar Interbody Fusion With Cement Augmentation Without Posterior Fixation to Treat Isthmic Spondylolisthesis in an Osteopenic Patient—A Surgical Technique, by Cyriac et al. Gaston Camino Willhuber. International Journal of Spine Surgery. 2019. PMID: 31531287
8. “Laminectomy”. Martin Estefan; Gaston Camino Willhuber. Treasure Island (FL): StatPearls Publishing; 2019. 2019 June 6. PMID: 3119441
9. “Os Odontoideum”. Matias Pereira Duarte; J Das; Gaston Camino Willhuber. Treasure Island (FL): StatPearls Publishing; 2019. 2019 June 6. PMID: 3119443
10. “Nucleus Pulposus Herniation”. Franco L De Cicco; Gaston Camino Willhuber. Treasure Island (FL): StatPearls Publishing; 2019. 2019 June 6. PMID: 31194447
11. "Osteosarcoma “tipo Osteoblastoma” de columna cervical. A propósito de un caso". Gaston Camino Willhuber; Gonzalo Kido; Martin Estefan; Maximiliano Mereles; Julio Bassani; Matias Petracchi; Carlos Sola; Marcelo Gruenberg. Rev Asoc Argent Ortop Traumatol 2019; 84 (2): 149-154 • ISSN 1852-7434
12. “Straight Leg Raise Test”. Camino Willhuber GO, Piuzzi NS. Treasure Island (FL): StatPearls Publishing; 2019. 2019 Apr 1. PMID: 30969539
13. “Biomechanical comparison between standard and inclined screw orientation in dynamic hip screw side-plate fixation. The lift-off phenomenon”. Ivan Zderic, Gaston Camino Willhuber, Mark-Daniel Ahrend, Carlos Sancineto, Florian Gras, Jorge Barla, Markus Windolf, Boyko Gueorguiev. Journal of Orthopaedic TranslationNov 2018. https://doi.org/10.1016/j.jot.2018.10.005 PMID: 31508312
14. “Letter to the Editor concerning “Proposal for a new trajectory for subaxial cervical lateral mass screws” by S. Amhaz‑Escanlar et al. (Eur Spine J; 2018: doi:10.1007/s00586‑018‑5670‑5)”. Gaston Camino Willhuber. Eur Spine J 2018 Aug. https://doi.org/10.1007/s00586-018-5713-y. PMID: 30078054
15. “Analysis of postoperative complications in spinal surgery, hospital length of stay and unplanned readmission. Application of Dindo-Clavien classification to spine surgery”. Gaston Camino Willhuber; Cristina Elizondo; Pablo Slullitel. Global Spine J 2018 Jul. doi: 10.1177/2192568218792053. PMID: 31192095
16. “Short term complication rate following orthopaedic surgery in a tertiary care centre in argentina”. Gaston Camino Willhuber, MD, Joaquin Stagnaro, MD, Matias Petracchi, MD, Agustin Donndorff, MD, Daniel Godoy Monzon, MD, Juan Astoul Bonorino, MD, Danilo Taype Zamboni, MD, Facundo Bilbao, MD, Jose Albergo, MD, Nicolas S. Piuzzi, MD, Santiago Bongiovanni, MD. SICOT J.2018. 4:26. doi: 10.1051/sicotj/2018027. PMID: 29956663
17. “Answer to the Letter to the Editor of Biao Wang et al. concerning "Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients" by Sola C, Camino Willhuber G, Kido G et al. Eur Spine J (2018): doi: 10.1007/s00586-018-5547-7". Gaston Camino Willhuber and Carlos Sola. Eur Spine J.2018 Jul;27(7):1667-1668. doi: 10.1007/s00586-018-5643-8. PMID: 2980418
18. “Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients”. Carlos Sola; Gaston Camino Willhuber; Gonzalo Kido; Matias Pereira Duarte; Mariana Bendersky; Maximiliano Mereles; Matias Petracchi; Marcelo Gruenberg. Eur Spine J 2018, 1-9. DOI:1007/s00586-018-5547-7. PMID: 29569159
19. “Analysis of risk factors for new vertebral fracture after percutaneous vertebroplasty”. Borensztein, Matias;Camino Willhuber, Gaston; Gruenberg, Marcelo; Posadas Martinez, Maria; Sola, Carlos; Velan, Osvaldo. Global Spine J. Oct 2017. DOI: 10.1177/2192568217732988. PMID: 30258749
20. "Biomechanical Analysis Of The Proximal Femoral Locking Compression Plate: Do Quality Of Reduction And Screw Orientation Influence Construct Stability?". Zderic I, Oh JK, Stoffel K, Sommer C, Helfen T, Camino G, Richards RG, Nork SE, Gueorguiev B. J Orthop Trauma.2017 Aug 22. DOI: 10.1097/BOT.0000000000001008. PMID: 28834823
21. “Factors associated with lumbar disc hernia recurrence after microdiscectomy”. Camino Willhuber, Gaston; Kido, Gonzalo; Mereles, Maximiliano; Bassani, Julio; Petracchi, Matias; Elizondo, Cristina; Gruenberg, Marcelo; Sola, Carlos. Rev Esp Cir Ortop Traumatol. DOI: 10.1016/j.recot.2017.07.002. PMID: 28899699
22. “Usefulness of Tokuhashi score in survival prediction of patients operated for vertebral metastatic disease”. Marcelo Gruenberg; Maximiliano E. Mereles; Gastón O. Camino Willhuber; Marcelo Valacco; Matias G. Petracchi; Carlos A. Sola. Global Spine J.2017 May;7(3):260-265. DOI: 10.1177/2192568217699186. Epub 2017 Apr 11. PMID: 28660109
23. “Craniocervical Spinal Instability after Type 1 Arnold Chiari Decompression”. A Case Report. Camino Willhuber, Gaston; Bosio, Santiago; Halliburton, Carolina; Puigdevall, Miguel; Sola, Carlos; Maenza Ruben.The Journal of Pediatric Orthopaedics B. 2017 Jan;26(1):80-85. DOI: 1097/BPB.0000000000000346 PMID: 2725836
24. “Arthroscopic Fixation of Os Acetabuli Technique: When to Resect and When to Fix”. Cecilia Pascual-Garrido, M.D., John B. Schrock, B.S., Justin J. Mitchell, M.D., Gaston Camino Willhuber, M.D., Omer Mei-Dan, M.D., and Jorge Chahla, M.D. Arthroscopy Techniques. 2016 Oct 10;5(5):e1155-e1160. DOI: 10.1016/j.eats.2016.07.001. PMID: 28224071
25. “Comparación de resultados clínico-radiológicosentre prótesis total y artrodesis de tobillo para el tratamiento de la artrosis postraumática”. Pablo Slullitel, Gastón Camino Willhuber, Nicolás Piuzzi, Joaquín Stagnaro,Fernando Diaz Dilernia, Mariano Revah, Ezequiel Zaidenberg, Gala Santini Araujo,Pablo Sotelano, Marina Carrasco. latinoam. cir. ortop. 2017 http://dx.doi.org/10.1016/j.rslaot.2017.02.005
26. “Osteosíntesis directa en espondilolistesis traumática de el axis. Reporte de un caso y revisión bibliográfica”. Matias Petracchi; Gaston Camino Willhuber; Juan Gonzalez Viezcas; Franco de Cicco; Marcelo Gruenberg; Carlos Sola. Revista Argentina de Ortopedia y Traumatologia AAOT August 2016. http://dx.doi.org/10.15417/2525-1015.2016.81.657
27. “Monosegmental combined anterior posterior instrumentation for the treatment of a severe lumbar tuberculous spondylodiscitis: case reportand literature review”. Petracchi Matias, Camino Willhuber Gaston, Tripodi Maria, Bassani Julio, Gruenberg Marcelo, Sola Carlos. Revista Brasileira de Ortopedia. http://dx.doi.org/10.1016/j.rboe.2016.12.010. PMID: 29234660
28. “Migration of the Anterior Spinal Rod to the Right Thigh, a Rare Complication of Anterior Spinal Instrumentations: A Case Report and a Literature Review”. Camino Willhuber Gaston, Taype Zamboni Danilo, Carabelli Guido, Barla Jorge, and Sancineto Carlos. Case Reports in Orthopedics. Volume 2015, Article ID 532412, 4 pages http://dx.doi.org/10.1155/2015/532412. PMID: 26613058
29. “Analysis of Sacro-Iliac joint screw fixation: Do quality of reduction and screw orientation influence joint stability? A biomechanical study”. G Camino Willhuber , I Zderic, F Gras , D Wahl, C Sancineto, J Barla, M Windolf , RG Richards , B Gueorguiev. International Orthopaedics. 2016. Jul;40(7):1537-43. DOI: 10.1007/s00264-015-3007-0. Epub 2015 Oct 5. PMID: 26435263
30. "Análisis de la función y ultra estructura mitocondrial en ratones albinos sanos tratados con medicamentos para insuficiencia cardíaca.” Gaston Oscar Camino Willhuber, Gustavo Guzman Mentesana, Alejandra Baez, Silvina Lo Presti, Carolina Bazán, Mariana Strauss, Ricardo Fretes, Patricia Adriana Paglini-Oliva, Hector Walter Rivarola. Rev Fac Cien Med Univ Nac Cordoba. Sep 8;74(3):15297. PMID: 29890097
31. “Use of clomipramine as chemotherapy of the chronic phase of Chagas disease”. Romina Fauro, Silvina Lo Presti, Carolina Bazan, Alejandra Baez,Mariana Strauss, Fernanda Triquell, David Cremonezzi, Olga Sanchez Negrete, Gaston Camino Willhuber, Patricia Paglini-Oliva and Walter Rivarola. 2013 Jun;140(7):917-27.PMID: 23534690
32. “Persistence of Trypanosoma Cruzi in Experimental Chagasic Cardiomyopathy”. Bazan C, Micucci L, Fauro R, Triquel M, Lo presti MS, Baez A, Strauss M, Camino Willhuber G, Pablini-Oliva O and Rivarola W. Anti-infective agents 01-2012 ISSN: 1568-0126
33. “Prevalence and associated risk factors of arterial hypertension in Sobremonte and Ojo de Agua Departments in Cordoba State”. Pedraza A, Camino Willhuber G, Chaile I. Rev Fac Cien Med Univ Nac Cordoba.2008;65(3):87-94. PMID: 20806553
Slullitel Pablo, Hospital Italiano de Buenos Aires
Grado academico maximo alcanzado: Medico, Especialista en Ortopedia y Traumatologia Medico asociado del servicio de Ortopedia y Traumatolgia del Hospital Italiano de Buenos Aires
publicaciones:
Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review Oñativia IJ, et al. Hip Int 2018. Among authors: Slullitel PA. PMID 28665454 Cite AMA MLA APA NLM Share
2 Hip arthroscopy in osteoarthritis: a systematic review of the literature Piuzzi NS, et al. Hip Int 2016 - Review. Among authors: Slullitel PA. PMID 26391259 Cite AMA MLA APA NLM Share
3 Periprosthetic stress fracture around a well-fixed type 2B short uncemented stem Slullitel PA, et al. SICOT J 2018. PMID 30058529 Free PMC article. Cite AMA MLA APA NLM Share
4 Re-admissions treble the risk of late mortality after primary total hip arthroplasty Slullitel PA, et al. Int Orthop 2018. PMID 29525914 Cite AMA MLA APA NLM Share
5 Transfusion rate using intravenous tranexamic acid in hip revision surgery Mariani P, et al. Hip Int 2018. Among authors: Slullitel PA. PMID 29890907 Cite AMA MLA APA NLM Share
6 Comment on Smeets et al.: 'The patellar pubic percussion test: a simple bedside tool for suspected occult hip fractures' Slullitel PA. Int Orthop 2018. PMID 30116868 Cite AMA MLA APA NLM Share
7 State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty Slullitel PA, et al. EFORT Open Rev 2018. PMID 30233819 Free PMC article. Cite AMA MLA APA NLM Share
8 Is a short stem suitable for patients with hip dysplasia? A report on technical problems encountered during femoral reconstruction Buttaro MA, et al. Hip Int 2018. Among authors: Slullitel PA. PMID 29048691 Cite AMA MLA APA NLM Share
9 Transfusion rate using intravenous tranexamic acid in hip revision surgery Mariani P, et al. Hip Int 2017. Among authors: Slullitel PA. PMID 29027188 Cite AMA MLA APA NLM Share
10 Long-term Outcome of Unconstrained Primary Total Hip Arthroplasty in Ipsilateral Residual Poliomyelitis Buttaro MA, et al. Orthopedics 2017. Among authors: Slullitel PA. PMID 27841928 Cite AMA MLA APA NLM Share
Taype Zamboni Danilo, Hospital Italiano de Buenos Aires
Grado academico maximo alcanzado: Medico, Especialista en Ortopedia y Traumatologia Medico asociado del servicio de Ortopedia y Traumatolgia del Hospital Italiano de Buenos Aires
publicaciones:

Migration of the Anterior Spinal Rod to the Right Thigh, a Rare Complication of Anterior Spinal Instrumentations: A Case Report and a Literature Review Gaston CW, et al. Case Rep Orthop 2015. Among authors: Danilo TZ. PMID 26613058 Free PMC article. Cite AMA MLA APA NLM Share
2 Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina Willhuber GC, et al. SICOT J 2018. Among authors: Zamboni DT. PMID 29956663 Free PMC article. Cite AMA MLA APA NLM Share
3 Preliminary outcomes of proximal femur megaspacers Sancineto CF, et al. Arthroplast Today 2019. Among authors: Taype Zamboni DRE. PMID 31286038Free PMC article. Cite AMA MLA APA NLM Share
4 Gluteal Compartment Syndrome Secondary to Pelvic Trauma Diaz Dilernia F, et al. Case Rep Orthop 2016. Among authors: Taype Zamboni DE. PMID 27579205Free PMC article. Cite AMA MLA APA NLM Share
5 Corrigendum to "Migration of the Anterior Spinal Rod to the Right Thigh, a Rare Complication of Anterior Spinal Instrumentations: A Case Report and a Literature Review" Camino Willhuber G, et al. Case Rep Orthop 2016. Among authors: Zamboni DT. PMID 27807493Free PMC article. Cite AMA MLA APA NLM Share
Albergo Jose, Hospital Italiano de Buenos Aires

Grado academico maximo alcanzado: Medico, Especialista en Ortopedia y Traumatologia Medico asociado del servicio de Ortopedia y Traumatolgia del Hospital Italiano de Buenos Aires
publicaciones:

1- Roitman PD, Jauk F, Farfalli GL, Albergo JI, Aponte-Tinao LA. Denosumab-treated giant cell tumor of bone. Its histologic spectrum and potential diagnostic pitfalls. Hum Pathol. 2017;63:89–97. doi:10.1016/j.humpath.2017.02.008

2-Farfalli GL, Albergo JI, Lobos PA, et al. Metástasis pulmonares en osteosarcoma. Neoadyuvancia, tratamiento quirúrgico y supervivencia [Osteosarcoma lung metastases. Survival after chemotherapy and surgery]. Medicina (B Aires). 2015;75(2):87–90.
Terrasa Sergio, Hospital Italiano de Buenos Aires

Grado academico maximo alcanzado: Medico, Especialista en Medicina Familiar Medico de planta del servicio de Medicina Familiar del Hospital Italiano de Buenos Aires
publicaciones:

1-Peper FE, Esteban S, Terrasa SA. Evaluación de la adherencia primaria a medicamentos en pacientes con enfermedades crónicas afiliados al Seguro de Salud del Hospital Italiano de Buenos Aires: estudio de cohorte retrospectiva [Evaluation of primary adherence to medications in patients with chronic conditions: A retrospective cohort study]. Aten Primaria. 2018;50(2):96–105. doi:10.1016/j.aprim.2017.01.013

2-Esteban S, Rodríguez Tablado M, Peper F, et al. Development and Validation of Various Phenotyping Algorithms for Diabetes Mellitus Using Data from Electronic Health Records. Stud Health Technol Inform. 2017;245:366–369.
Piuzzi Nicolas, Cleveland Clinic

Grado academico maximo alcanzado: Medico, Especialista en Ortopedia y Traumatologia Medico asociado del servicio de Ortopedia y Traumatolgia del Hospital Italiano de Buenos Aires
publicaciones:

1-Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee Osteoarthritis: A Primer. Perm J. 2017;21:16–183. doi:10.7812/TPP/16-183

2-Piuzzi NS, Strnad GJ, Sakr Esa WA, et al. The Main Predictors of Length of Stay After Total Knee Arthroplasty: Patient-Related or Procedure-Related Risk Factors. J Bone Joint Surg Am. 2019;101(12):1093–1101. doi:10.2106/JBJS.18.00758
Boretto Jorge, Hospital Italiano de Buenos Aires

Grado academico maximo alcanzado: Medico, Especialista en Ortopedia y Traumatologia Medico de planta del servicio de Ortopedia y Traumatolgia del Hospital Italiano de Buenos Aires
publicaciones:
1-Abrego MO, De Cicco FL, Montenegro NB, Boretto JG, De Carli P, Gallucci GL. Refractory actinomycosis of the humerus. SAGE Open Med Case Rep. 2018;6:2050313X17752852. Published 2018 Jan 9. doi:10.1177/2050313X17752852 2-Piuzzi NS, Costantini J, Carbo L, Makino A, Boretto JG. Soft-Tissue Expansion beforeTotal Knee Arthroplasty:A Report of Two Cases. J Orthop Case Rep. 2018;8(4):20–24. doi:10.13107/jocr.2250-0685.1140

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