gms | German Medical Science

Objective: The ranking systems are essential for science and quality management. Nowadays, there is a consensus in the neurosurgical field only regarding the use of some simple and less precise classifications such as “intra-/postoperative” and “minor/major” complications. These scales give no possibility to rank and compare the postoperatively occurred neurological disturbances. We aimed to design a classification, that could include all possible, postoperative, neurological disturbances and to prove its validity in terms of comparability and feasibility in the neurosurgical daily practice.

Methods: We designed a Classification with a total of seven grades commencing from grade “0” for no neurological disturbances to grade “6“ for coma/vegetative state/demise concentrating on the character and severity of functional restriction. We retrospectively analyzed a period of care between June 2017 and December 2019 in our neurosurgical department. The neurological complications were classified according to the CPNC from two independent raters. The agreement between the raters was statistically analyzed using Cohen’s kappa coefficient. The range of complications was also compared with the length of stay and statistically analyzed using two-sided Spearman’s rank correlation coefficients.

Results: The study included a total of 1681 operations at 1530 patients. It included 1158 (68,8%) operations on the spine, 46 (2,7%) on the peripheral nervous system, and 477 (28,4%) cases of cerebrovascular surgery. The postoperative neurological disturbances occurred in 7.7% (n=119) of patients, of which 34.45% were classified from both raters as grade 1, 34.45% from one and 32.77% from another rater as grade 2, 12.60% from both raters as grade 3, 7.56% from one rater and 10.08% from another rater as grade 4, 5.04% from one and 4,20% from another rater as grade 5 and 5.88% from both raters as grade 6. The agreement between the raters was statistically “almost perfect”, according to Landis and Koch, with K = 0,94. The ranking system was proportional to the length of hospital stay.

Conclusion: The CPNC can be useful in neurosurgery to assess the rates of postoperatively occurred neurological disturbances. We can recommend the CPNC as an easily applicable and comparable instrument in the quality management in neurosurgery.

Table 1 [Tab. 1]