Abstract：
OBJECTIVE: Currently there is no standardized mechanism to describe or compare complications in adult spine surgery. Thus, the purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery.
METHODS: The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss\' and Cohen\'s kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively.
RESULTS: Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785-0.908) and 0.852 (95% CI 0.791-0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644-0.912), 0.698 for grade II (95% CI 0.564-0.832), 0.861 for grade III (95% CI 0.727-0.996), 0.845 for grade IV-A (95% CI 0.711-0.979), 0.962 for grade IV-B (95% CI 0.828-1.097), and 0.960 for grade V (95% CI 0.826-1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944-0.999) for rater 1, 0.963 (95% CI 0.926-1.001) for rater 2, and 0.926 (95% CI 0.869-0.982) for rater 3.
CONCLUSIONS: The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.
METHODS: The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss\' and Cohen\'s kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively.
RESULTS: Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785-0.908) and 0.852 (95% CI 0.791-0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644-0.912), 0.698 for grade II (95% CI 0.564-0.832), 0.861 for grade III (95% CI 0.727-0.996), 0.845 for grade IV-A (95% CI 0.711-0.979), 0.962 for grade IV-B (95% CI 0.828-1.097), and 0.960 for grade V (95% CI 0.826-1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944-0.999) for rater 1, 0.963 (95% CI 0.926-1.001) for rater 2, and 0.926 (95% CI 0.869-0.982) for rater 3.
CONCLUSIONS: The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.
摘要：
目的：目前尚无标准化的机制来描述或比较成人脊柱手术中的并发症。因此，本研究的目的是修改和验证Clavien-Dindo-Sink并发症分类系统在脊柱外科中的应用.
方法：由四名受过研究培训的脊柱外科医生使用共识程序对Clavien-Dindo-Sink并发症分类系统进行了评估和修改。由三名受过研究金训练的脊柱外科医生组成的不同小组完成了一项随机电子调查，对71种现实生活中的临床病例进行了分级。调查在最初完成后2周重复进行。使用Fleiss\'和Cohen\'skappa（κ）统计数据来评估评估者之间和内部可靠性，分别。
结果：总体而言，第一轮和第二轮评分期间的观察者间可靠性非常好，κ为0.847(95%CI0.785-0.908)和0.852(95%CI0.791-0.913)，分别。在第一轮中，评估者间的可靠性范围从良好到优异，I级的κ为0.778(95%CI0.644-0.912)，II级0.698（95%CI0.564-0.832），三级0.861（95%CI0.727-0.996），对于IV-A级为0.845（95%CI0.711-0.979），对于IV-B级为0.962（95%CI0.828-1.097），V级为0.960（95%CI0.826-1.094）。所有三个独立观察者的观察者内部可靠性测试均非常出色，评估者1的κ为0.971（95％CI0.944-0.999），评估者2的0.963（95％CI0.926-1.001）和0.926（95％CI0.869-0.982）。
结论：改良的Clavien-Dindo-Sink分类系统在成人脊柱手术病例中显示出出色的评分者和评分者内可靠性。该系统提供了一个有用的框架来更好地传达脊柱相关并发症的严重程度。
方法：由四名受过研究培训的脊柱外科医生使用共识程序对Clavien-Dindo-Sink并发症分类系统进行了评估和修改。由三名受过研究金训练的脊柱外科医生组成的不同小组完成了一项随机电子调查，对71种现实生活中的临床病例进行了分级。调查在最初完成后2周重复进行。使用Fleiss\'和Cohen\'skappa（κ）统计数据来评估评估者之间和内部可靠性，分别。
结果：总体而言，第一轮和第二轮评分期间的观察者间可靠性非常好，κ为0.847(95%CI0.785-0.908)和0.852(95%CI0.791-0.913)，分别。在第一轮中，评估者间的可靠性范围从良好到优异，I级的κ为0.778(95%CI0.644-0.912)，II级0.698（95%CI0.564-0.832），三级0.861（95%CI0.727-0.996），对于IV-A级为0.845（95%CI0.711-0.979），对于IV-B级为0.962（95%CI0.828-1.097），V级为0.960（95%CI0.826-1.094）。所有三个独立观察者的观察者内部可靠性测试均非常出色，评估者1的κ为0.971（95％CI0.944-0.999），评估者2的0.963（95％CI0.926-1.001）和0.926（95％CI0.869-0.982）。
结论：改良的Clavien-Dindo-Sink分类系统在成人脊柱手术病例中显示出出色的评分者和评分者内可靠性。该系统提供了一个有用的框架来更好地传达脊柱相关并发症的严重程度。
