%0 Journal Article
%T Modified Clavien-Dindo-Sink Classification System for operative complications in adult spine surgery.
%A Ridolfi D
%A Oyekan AA
%A Tang MY
%A Chen SR
%A Como CJ
%A Dalton J
%A Gannon EJ
%A Jackson KL
%A Bible JE
%A Kowalski C
%A de Groot SJ
%A Donaldson WF
%A Lee JY
%A Shaw JD
%J J Neurosurg Spine
%V 40
%N 5
%D 2024 May 1
%M 38306652
%F 3.467
%R 10.3171/2023.11.SPINE23396
%X <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.