Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery

Clinical article

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Definitions of complications in spinal surgery are not clear. Therefore, the authors assessed a group of practicing spine surgeons and, through the surgeons' responses to an online and emailed survey, developed a simple definition of operative complications due to spinal surgery. To validate this assessment, the authors revised their survey to make it appropriate for a lay audience and repeated the assessment with a cohort of patients who underwent spine surgery.


The authors surveyed a cohort of practicing spine surgeons via email and a web-based survey. Surgeons were presented with various complication scenarios and were asked to grade the presence or absence of a complication as well as complication severity, with responses limited to “major complication” and “minor complication/adverse event.” The authors administered a similar assessment, modified for lay persons, to patients in a spinal surgery clinic.


Complete responses were obtained from 229 surgeons; orthopedic surgeons comprised the majority of respondents (73%). The authors obtained completed surveys from 197 patients. Overall, there was consistent agreement between physicians and patients regarding the presence or absence of a complication in the majority of scenarios (8 [73%] of 11 scenarios with agreement that a complication was present). The overall kappa value, evaluating major versus minor complication, and presence or absence of a complication over the entire cohort, was fair (κ = 0.21). The authors found greater variation between the cohorts when evaluating complication severity. Patients were consistently more critical than physicians in the majority of scenarios in which a difference was evident. In 4 scenarios, patients were more likely than surgeons to deem the scenario a complication and to grade the complication as major versus minor (p < 0.01). In 3 additional scenarios, patients were more likely than physicians to grade a major complication as opposed to minor complication (p < 0.01). In only 1 scenario were patients less likely than physicians to report a complication (p < 0.001).


Comparing responses of spine surgeons and patients who underwent spinal surgery in assessing a group of common postoperative events, the authors found significant agreement on perception of presence of a complication in the majority of scenarios reviewed. However, patients were consistently more critical than surgeons when differences in reporting were found. The authors' data underscore the importance of reconciling differing opinions regarding complications through open discussions between physicians and patients to ensure accurate patient expectations of planned medical or surgical interventions.

Abbreviations used in this paper: ACDF = anterior cervical discectomy and fusion; DVT = deep venous thrombosis; ROM = range of motion; UTI = urinary tract infection.

Article Information

Address correspondence to: John K. Ratliff, M.D., Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, Pennsylvania 19107. email:

© AANS, except where prohibited by US copyright law.



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    Graphs. Upper: Patients and physicians consistently agreed on presence of a complication in the majority of scenarios reviewed. The overall kappa value for the entire cohort was fair (κ = 0.21). Lower: Physicians and patients consistently agreed on complication severity. When differences were found, using multivariate analysis patients were consistently more critical than physicians: they were more likely to find that a complication had occurred and more likely to deem a major as opposed to minor complication (p < 0.001).


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