Article
The implementation of the classification of intraoperative adverse events (ClassIntra) for neurosurgical procedures – a prospective monocentric study
Die praktische Anwendung der ClassIntra-Klassifikation zur Monitoring intraoperativer Komplikationen bei neurochirurgischen Eingriffen – eine prospektiv-monozentrische Studie
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Authors
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Richard Drexler
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Franz Lennard Ricklefs
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Rainer Nitzschke
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland; Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Anästhesiologie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Lasse Dührsen
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Monitoring and quality improvement is increasingly important in surgery. As there are well-defined scores and classifications to describe the postoperative outcome regarding morbidity, mortality and neurological status, no validated classification for intraoperative quality exists. Dell-Kuster et al. introduced the ClassIntra Score as a novel classification for assessing intraoperative adverse events. It defines intraoperative adverse events as any deviation from the ideal intraoperative course and contains any event related to surgery and anesthesia. To date, the score is not yet validated for neurosurgical procedures.
Methods: A prospective, monocentric study between 01st July and 30th November 2021 was conducted. The ClassIntra severity grade for each neurosurgical procedure was evaluated during team-sign-out at the end of surgery (Grade 0 to V). All patients were followed up until discharged from hospital and 30 days after surgery. Postoperative complications were graded according to the Clavien-Dindo classification and Comprehensive Complication Index (CCI). Neurological status was assessed prior surgery and at discharge using NIHSS, NANO, GCS and mRS.
Results: 407 neurosurgical procedures were included. Of those, 357 (87.7%) were elective surgeries, 50 (12.3%) were emergency surgeries. The majority (94.1%) underwent surgery for an intracranial pathology, whereas 24 patients (5.9%) had spine or peripheral nerve surgery. In elective intracranial surgery, a ClassIntra grade II or greater correlated with a significant decrease of neurological status at discharge, a significantly higher postoperative Clavien-Dindo grade, longer ICU and hospital stay, increased rate of unscheduled CT or MRI scan, and higher in-hospital mortality (p<0.01). A poorer Karnofsky index, anticoagulant intake, and lower hemoglobin preoperatively were predictors for a higher ClassIntra grade (p<0.05). Intraoperative features (pathology, location, positioning, monitoring) had no influence on the ClassIntra grade.
Conclusion: In 407 procedures we could show a strong association between the ClassIntra grade and patients outcome. We highlight the potential of the ClassIntra for predicting postoperative complications, unscheduled scans, and prolonged ICU stay. Hence implementation of ClassIntra could have a lasting effect on postoperative care and improve patients outcome.
