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Registering complications is important in surgery, since complications serve as outcome measures and indicators of quality of care. Few studies have addressed the variation in severity and consequences of complications. We hypothesized that complications show much variation in consequences and severity.
We conducted a prospective observational coho...
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Context 1
... admitted patients who did not undergo surgery, 465 of 552 (84%) consequences of the complication were recorded. The various types of procedures performed, and their respective complication rates are outlined in Table 1. Table 2 illustrates the severity of complications following various types of surgery. ...
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Citations
... The incidence of postoperative complications is used as a measure of surgical quality, but there is no consensus on what constitutes a complication and how severe it is, making it difficult to compare outcomes [16]. The majority of reports have evaluated postoperative complications using a non-standardized system and have not accounted for the severity of complications. ...
Objective
To assess functional outcomes and classify postoperative complications of augmentation cystoplasty by the Clavien-Dindo classification system.MethodsA total of 197 adult patients undergoing augmentation cystoplasty between January 2016 and December 2020 at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), were included in the study after obtaining approval from the ethics review committee. Patients’ records were reviewed for assessment of complications up to 3 months of follow-up. Functional outcomes were assessed by comparing preoperative video urodynamics study (VUDS) findings with follow-up VUDS findings at 1 year. IBM SPSS v23 was used to record and analyze all the complications, treatments, and pre- and postoperative VUDS data.ResultsOf the 197 patients included in this study, 127 (64.5%) were male and 70 (35.5%) were female. The mean age of the patients was 38.4 ± 9.92 years. Eighty-seven patients (44.2%) remained complication-free, 64 patients (32.5%) had grade I-II complications, 44 patients (22.3%) had grade III and IV complications, and only 2 patients (1%) had grade V complications. Stomal stenosis was the most frequent complication, occurring in 14.7% of patients, followed by renal function deterioration and high-grade fever, each noted in 13.7% of patients. Mean preoperative bladder capacity was 144.3 ± 63.09 mL, mean preoperative filling pressure was 43.34 ± 26.92 cm3 H2O, while mean postoperative bladder capacity was 460.83 ± 70.69 mL and mean postoperative filling pressure was 7.47 ± 5.79 cm3 H2O.Conclusion
Augmentation cystoplasty can increase bladder capacity and improve bladder function. Because of the potential for complications, it is essential to carefully choose patients for surgery and provide proper preoperative counseling. Additionally, it is crucial to give proactive postoperative care.
... Since SG and RYGB complication rates are relatively low, especially regarding severe postoperative complications (at the level of 1.5%-4%), patients tend to mistake bariatric surgeries for cosmetic procedures or 1-day surgeries [4][5][6]. In general, severe complications (requiring endoscopic, radiological, or surgical intervention or even intensive care management) are also often associated with prolonged hospitalization, increased hospital readmission risk, and additional costs [7,8]. In other fields of surgery (e.g., oncology), the occurrence of severe postoperative complications affects both short-and long-term results and is associated with a deterioration of treatment results and quality of patients' life [9][10][11]. ...
Background
Bariatric surgery has relatively low complication rates, especially severe postoperative complications (defined by Clavien-Dindo classification as type 3 and 4), but these rates cannot be ignored. In other than bariatric surgical disciplines, complications affect not only short-term but also long-term results. In the field of bariatric surgery this topic has not been extensively studied.
Objectives
The aim of the study was to assess the outcomes of bariatric treatment in patients with obesity and severe postoperative complications in comparison to patients with a noneventful perioperative course.
Setting
6 surgical units at XXXXX public hospitals.
Methods
We performed a multicenter propensity score matched analysis of 206 patients from 6 XXXXX surgical units and assessed the outcomes of bariatric procedures. 103 patients with severe postoperative complications (70 laparoscopic Sleeve Gastrectomy (SG) and 33 laparoscopic Roux en Y Gastric Bypass (RYGB)) were compared to 103 patients with no severe complications in terms of peri- and postoperative outcomes.
Results
The outcomes of bariatric treatment did not differ between compared groups. Median percentage of total weight loss (%TWL) 12 months after the surgery was 28.8% in the group with complications and 27.9% in patients with no severe complications (p=0.993). Remission rates of both: type 2 diabetes mellitus and arterial hypertension, showed no significant difference, SG vs RYGB respectively: 36% vs 42%, p=0.927 and 41 vs 46%, p=0.575.
Conclusions
The study suggests that severe postoperative complications had no significant influence either on weight-loss effects or obesity-related diseases remission.
... The cost-utility analysis was limited by the amount of data concerning the influence of post-operative complications on quality of life. The results are based on the findings of a single study which used the WHOQOL-BREF instrument to measure quality of life following colorectal surgery [18]. It was not possible to calculate quality of life in terms of quality-adjusted life years (QALYs), and therefore it was inappropriate to apply a willingness-to-pay threshold to the cost-effectiveness plane. ...
Background
Despite medical advances, major surgery remains high risk with up to 44% of patients experiencing postoperative complications. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long-term disability. The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient’s mobility. The aim of this study was to evaluate the feasibility, acceptability and clinical outcomes of continuous remote monitoring after major surgery.
Methods
The study was a randomised, controlled, unblinded, parallel group, feasibility trial. Adult patients undergoing elective major surgery were randomly assigned to receive continuous remote monitoring and normal National Early Warning Score (NEWS) monitoring (intervention group) or normal NEWS monitoring alone (control group). Continuous remote monitoring was achieved using the SensiumVitals® wireless patch which is worn on the patient’s chest and monitors heart rate, respiratory rate and temperature continuously, and alerts the nurse when there is deviation from pre-set physiological norms. Feasibility was assessed by evaluating recruitment rate, adherence to protocol and randomisation and the amount of missing data. Clinical outcomes included time to antibiotics in cases of sepsis, length of hospital stay, number of critical care admissions and rate of hospital readmission within 30 days of discharge.
Results
One hundred and thirty-six patients were randomised between October 2018 and April 2019: 67 to the control group and 69 to the intervention group. Recruitment was completed prior to the 12 month target with a high rate of eligibility and consent. Missing data was limited only to questionnaire responses; no participants were lost to follow-up and only one participant was withdrawn due to loss of capacity. The number of patients classed as ‘drop-out’ due to design (8.1%) were less than anticipated, and there were no participants who crossed over into the alternative trial allocation group. Seventeen participants in the intervention group (28%) did not adhere to the monitoring protocol. No formal comparisons between arms was undertaken; however, participants had fewer unplanned critical care admissions (1 versus 5) and had a shorter average length of hospital stay (11.6 days (95% confidence interval 9.5–13.7 days) versus 16.2 days (95% confidence interval 11.3–21.2 days)) in the continuous vital signs monitoring group. The time taken to receive antibiotics in cases of sepsis was similar in both arms. A cost-utility analysis indicated that the remote monitoring system was cost-saving when compared to standard NEWS monitoring alone.
Conclusions
It is feasible to perform a large-scale randomised controlled trial of continuous remote monitoring after major surgery. Progression to a definitive multicentre randomised controlled trial would be appropriate, taking consideration of factors, such as patient adherence, that might mask the potential benefit of additional monitoring.
Trial registration
ISRCTN registry with study ID ISRCTN16601772. Registered 30 August 2017.
... A globally used standardised quality assessment system will make the data reproducible and may help in decreasing the preventable causes of surgical complications. 6 The Clavien-Dindo (CD) classification shows promise in this regard as it has been used most frequently all over the world. 7 It utilises a five-grade system that categorises the complications by the therapeutic modality used to treat that particular complication (Table 1). ...
Objective:
To determine the incidence of complications in elective surgeries and to grade them according to the Clavien-Dindo Classification System.
Methods:
The cross-sectional study was conducted in the General Surgery Operation Theatre of Holy Family Hospital, Rawalpindi, Pakistan, from February to April 2018, and comprised patients undergoing elective surgeries. Age, gender, region of surgery, type and grade of complications, were recorded using Clavien-Dindo Classification proforma. Data was analysed using SPSS 23.
Results:
Of the total 212 patients, 36(16.9%) had some complication. There were significantly more complications in people aged 40 years or above compared to those <40 years (p<0.05). Of the total surgeries, 126(59.43%) were in the abdomino-pelvic region.
Conclusions:
Peri-operative complications were found to be significantly related with age of the patient and the type of surgery.
... The risk for preterm birth in a subsequent pregnancy can increase in women who underwent late CS either due to injuries to the cervix following the prolonged second stage of labor or direct injury of the cervix sustained during a cesarean delivery [16]. Registering complications is important in surgery since complications serve as outcome measures and indicators of quality of care [17]. Although the rate of complications was found to be more in cesarean sections done in the second stage of labor in the previous studies, the actual rate quoted was variable. ...
Background
Cesarean section (CS) done before onset of labor is called elective and done during labor is called emergency. During labor, CS may be needed in early(1st) or late(2nd) stages. Earlier studies have shown more maternal and fetal complications when cesarean is done for the first time in late stages.
Objective
Our objective was to find out whether the maternal & fetal outcomes differ when primary CS is done in first stage of labor compared to second stage of labor for various indications and how.
Method
This was a retrospective observational study of women who underwent primary CS during active labor and to link the maternal and fetal outcomes related to the stages of labor. The study population was patients admitted to Labor ward of Saqr hospital, Ras Al Khaimah, UAE, between 1st January 2017 till 31st December 2017, but had to undergo primary CS during labor for various indications at 1st and 2nd stage of labor. Data was collected from maternal and neonatal electronic case records.
Results
A total of 135 case records were studied. Most CSs were in early stage of labor. Most common indications were fetal distress and prolonged labor. The maternal and fetal complications were higher in 2nd stage of labor than in 1st stage which includes uterine atonia (p=.001), postpartum hemorrhage (p=.006), postoperative hematuria(RR=3.46), problems with breast feeding (p=0.001) and fetal injuries (p=.001).
Conclusion
Primary CS in late labor is associated with increased maternal and neonatal complications compared to CS in early labor.
... Cerebrospinal fluid leakage (CFSL) and postoperative transient neurological deterioration (PTND) are the two most common complications following surgeries (Hou et al., 2017;Xu et al., 2017). CSFL is reported to be related with a large number of complications such as meningitis, hematoma, hemorrhage, abscess fistulas, decreased intracranial pressure (Hu et al., 2016) and various other neurological complications, causing prolonged hospitalization and increasing risk of infection (Bosma et al., 2012), considering this, CSFL is regarded as a severe surgical complication in TSS surgeries (Orts-Del'Immagine et al., 2020;Ohata et al., 2019;Kotani et al., 2019;Miyan et al., 2019). ...
... . Previous reports have highlighted a list of complications after surgical decompression in TSS patients, in which the most common one is CSFL(Ando et al., 2013;Yu et al., 2013;Zhang et al., 2016;Fang et al., 2017;Barber et al., 2019). However, there are very limited studies, specifically those exploring the correlation of CSFL and surgical outcomes of TSS patients but the result remains controversial(Bosma et al., 2012;Hu et al., 2016;Zhang et al., 2016;Fang et al., 2017;Garry, 2018;Barber et al., 2019;Ruan et al., 2019;Gu et al., 2019;Bhrini et al., 2020;Ruan et al., 2019;Pluim et al., 2019). This study investigates the effect of CSFL on the outcome of TSS and reports an interesting finding.Result showed that there is a higher incidence of CSFL among Non-PTND group than that of PTND group (Non-PTND: 47.06% and PTND:17.65%), which indicates that CSFL may be relevant with a lower incidence of PTND. ...
The study was designed to investigate the effect of cerebrospinal fluid leakage (CFSL) on the surgical outcomes of thoracic spinal stenosis (TSS). 153 TSS cases were recruited for this study from January 2012 to December 2017. Preoperative duration of symptoms, neurological status, operative parameters, postoperative courses and neurological recovery were collected. Modified Japanese Orthopedic Association (JOA) score for thoracic myelopathy was used to assess neurological status, and recovery rate was calculated, accordingly. Comparison was between postoperative transient neurological deterioration (PTND) group and Non-PTND group. Cases were further grouped into favorable outcome (FO) (JOA recovery rate≥25%) and unfavorable outcome (UO) (JOA recovery rate＜25%) group, respectively. Further, multivariate logistic regression was performed to verify their relationships. Result showed that thirty-three patients (25.6%) developed PTND, while sixty-seven patients (43.8%) developed CSFL. The mean JOA recovery rate was 58.2 ± 35.3%. The incidence of CSFL in PTND group was significantly lower than that in non-PTND group (17.65% vs 47.06%, p = 0.02). Multiple regression analysis showed that CSFL indicated a lower incidence of PTND (B = 1.608 p = 0.03). However, there was no significant difference between the incidence of CSFL in FO group and that of UO group (27.28% vs 46.56%, p = 0.09). In addition, preoperative duration of symptoms, preoperative JOA score and blood loss were associated with the surgical outcomes. The present study found that CSFL was associated with a lower risk of PTND in TSS, which has a certain guiding significance for clinical surgery.
... [1] The frequency of postoperative complications is used as an indicator of surgical quality; however, comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. [2] Most reports have used a nonstandardized system for evaluating postoperative complications and have not taken the severity of complications into account. Terms such as "minor," "moderate," and "severe" have been used, but they are subjective, unreliable, and often defined differently by each author. ...
Background:
The frequency of postoperative complications is used as an indicator of surgical quality; however, comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. A standard grading system for surgical complications is necessary to improve the quality of clinical research and reporting in head and neck reconstruction.
Methods:
The aim of this study was to compare postoperative morbidity after microvascular head and neck reconstruction between patients with versus without a history of prior radiation therapy (RT) by using the Clavien-Dindo classification. A group of 274 patients was divided into two cohorts based on the history of prior RT: the RT group included 79 patients and the non-RT group included 195 patients. Postoperative (30-day) complications were compared between the groups with a nonstandardized evaluation system and the Clavien-Dindo classification.
Results:
The grades of complications according to the Clavien-Dindo classification were significantly higher in the RT group than in the non-RT group. The frequency of postoperative complications did not differ significantly between the groups according to the nonstandardized evaluation system.
Conclusions:
The Clavien-Dindo classification could serve as a useful, highly objective tool for grading operative morbidity after microvascular head and neck reconstruction when comparing similar defects and methods of reconstruction. Widespread use of the Clavien-Dindo classification system would allow adequate comparisons of surgical outcomes among different surgeons, centers, and therapies.
... 1 Registering complications is important in surgery, since complications serve as outcome measure and indicators of quality of care. [2][3][4] The use of standardised, valid and reliable definitions is fundamental to the accurate measurement and monitoring of surgical adverse events. 5 Complications in trauma care may occur because of provider-related or patient disease-related events. ...
BACKGROUND: Due to the invasive nature required for support and multiple therapeutic interventions, critically ill patients are at high risk of complications unrelated to their underlying illness or injury. This audit aimed to describe the spectrum of complications in a trauma intensive care unit, to identify potential remedial interventions to improve quality of care and reduce morbidityMETHODS: Complications in the Trauma Intensive Care Unit at Inkosi Albert Luthuli Central Hospital are documented prospectively on a specific proforma. A 12-month audit was performed between 2012-2013. Complications were divided into septic and non-septic adverse events and the relationship to injury severity, time of onset and outcome were analysedRESULTS: Of 283 patients admitted during the study period, 77 (32.5%) suffered a total of 161 adverse events. Ninety-seven (60.2%) complications were sepsis-related and 64 (39.2%) were unrelated to sespis. Ventilator-associated pneumonia was the commonest septic event (38.1%) and extubation-related events the most frequent non-septic complication (45.3%). The number of complications ranged from one in the majority of patients (49.4%) to 6 (3.9%) in 3 patients. There was no significant difference in mortality between those with (24.7%) or without (17.4%) complications (p = 0.22) however, those with complications had a significantly longer length of ICU stay (p
... The classification and categorization of complications were different in all the included studies, emphasizing the need for international standards on institutional quality control systems and complication classification. It seems likely that a classification system according to complication severity would be most applicable to a cross-specialty surgical registry 20 . ...
Background
An institutional registry covering all surgical specialties could be an implementation tool in quality benchmarking between hospitals and aid determination of their cost‐effectiveness. The objective of this systematic literature review was to evaluate original articles on existing prospective surgical registries that can be used by single institutions across surgical specialties.
Method
A systematic review of the literature using PRISMA guidelines was conducted for articles focusing on hospital‐wide surgical registries. Single‐specialty retrospective registries, non‐defined outcome measures or system protocols, and studies not in English were excluded.
Results
Five articles were included for analysis. Evaluation of the articles revealed wide methodological heterogeneity in the classification and categorization of complications and data collection methods.
Conclusion
Ideal surgical quality monitoring systems should be real‐time, contain patient‐related risk factors, and encompass all surgical specialties. At present, such institutional registries are rarely reported and no consensus exists on their standard definitions and methodology.
... Por otra parte; alrededor de un 35 % requiere, al menos, procederes diagnósticos o terapéuticos adicionales. 5 Se debe señalar que en algunos reportes importantes, si bien la incidencia de complicaciones quirúrgicas ha aumentado con el tiempo, la incidencia de eventos fatales ha disminuido. 6 Esto puede estar en relación con el mejor entendimiento de la fisiopatología de las enfermedades, el desarrollo de las técnicas de diagnóstico y las pautas de tratamiento basadas en la evidencia científica. ...
Postoperative complications in patients undergoing thoracic or abdominal major surgery are frequent events associated with a poor evolution. The aim of this paper is to clarify the definitions, epidemiological characteristics and classifications postoperative complications severity in most thoracic and abdominal surgery. A literature review on postoperative complications in most thoracic and abdominal surgery was carried out. Definitions are stated regarding postoperative complications. Reports are discussed concerning the incidence and mortality of the most important complications. Finally, the main tools for postoperative complications severity classification are discussed. Postoperative complications are frequent events that increase complications and mortality. Risk stratification tools should be applied, their appearance and severity should be closely monitored, as well as to act quickly and timely for a solution.
