Suggestion For a New Classification of Postoperative Neurological Complications (CPNC) in Neurosurgery

Abstract To design a classification concentrating on the art and severity of functional restriction that could include all possible postoperative neurological disturbances and prove its validity to be comparable and easily used in neurosurgery. A seven grade classification was proposed commencing from grade "0" for no neurological disturbances to grade "6" for coma/vegetative state/demise: grade “1”, any remittent neurological disturbances with full improvement spontaneously or as a result of any temporary drug therapy or re-surgery, a single epileptic seizure without the need for anticonvulsant therapy; grade “2”, lasting neurological disturbances resulting in no functional restrictions, no epileptic seizures needing for long-term anticonvulsant therapy; grade “3”, lasting neurological disturbances resulting in slight functional restrictions, rare epileptic seizures despite of anticonvulsant therapy, slight aphasia; grade “4”, lasting neurological disturbances resulting in moderate functional restrictions and partial need of outside help, average frequency of epileptic seizures despite anticonvulsant therapy, moderate aphasia; and grade “5”, lasting neurological disturbances resulting in severe functional restriction and complete need of outside help, high frequency of epileptic seizures despite of anticonvulsant therapy, severe aphasia. The study included a total of 1681 operations at 1530 patients. The postoperative neurological disturbances occurred in 7.7% (n=119) of patients. All postoperative neurological disturbances could be easily classified according to the CPNC. The ranking system was proportional to the length of hospital stay. The CPNC is useful and easily applicable to assess the rates of postoperative neurological disturbances. It can be a comparable instrument in the quality management of neurosurgery.