Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Complication Grading in Surgery

  • Chapter
  • First Online:
Complications in Robotic Urologic Surgery

  • 792 Accesses

Abstract

Reliable reporting of postoperative complications is essential for the assessment and comparison of surgical quality. Postoperative mortality has drastically decreased over the past decades; therefore, focus has shifted toward nonlethal endpoints. Standardized methodologies of complication grading are of paramount importance for such quality assessments. Inconsistent definitions of morbidity and surgical complications have been replaced by various intra- and postoperative complication grading systems. This chapter summarizes, compares, and discusses the most influential and widely used complication classifications and indexes of the past two decades. Additionally, it provides a small outlook into the future of outcome research and on prospective approaches of quality improvement in surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Clavien PA, et al. Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors. Ann Surg. 1992;216(6):618–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Pearse R, et al. Mortality after surgery in Europe reply. Lancet. 2013;381(9864):370–1.

    Article  PubMed  Google Scholar 

  3. Vonlanthen R, Clavien PA. What factors affect mortality after surgery? Lancet. 2012;380(9847):1034–6.

    Article  PubMed  Google Scholar 

  4. Whooley BP, et al. Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001;233(3):338–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Newman MF, Fleisher LA, Fink MP. Perioperative medicine : managing for outcome. Philadelphia: Saunders Elsevier. xix; 2008. p. 723.

    Google Scholar 

  6. Brennan MF, Radzyner M, Rubin DM. Outcome – more than just operative mortality. J Surg Oncol. 2009;99(8):470–7.

    Article  PubMed  Google Scholar 

  7. Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364(22):2128–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Feldman L, et al. Measuring postoperative complications in general surgery patients using an outcomes-based strategy: comparison with complications presented at morbidity and mortality rounds. Surgery. 1997;122(4):711–9; discussion 719–20.

    Article  CAS  PubMed  Google Scholar 

  9. Pomposelli JJ, et al. Surgical complication outcome (SCOUT) score: a new method to evaluate quality of care in vascular surgery. J Vasc Surg. 1997;25(6):1007–14; discussion 1014–5.

    Article  CAS  PubMed  Google Scholar 

  10. Gumbs AA, et al. Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg. 2008;12(4):707–12.

    Article  PubMed  Google Scholar 

  11. Beck-Schimmer B, et al. A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic. Ann Surg. 2008;248(6):909–18.

    Article  PubMed  Google Scholar 

  12. Trede M, Schwall G, Saeger HD. Survival after Pancreatoduodenectomy – 118 consecutive resections without an operative mortality. Ann Surg. 1990;211(4):447–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Seiler CA, et al. Randomized prospective trial of pylorus-preserving vs. classic duodenopancreatectomy (Whipple procedure): initial clinical results. J Gastrointest Surg. 2000;4(5):443–52.

    Article  CAS  PubMed  Google Scholar 

  14. DeOliveira ML, et al. Assessment of complications after pancreatic surgery – a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244(6):931–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002;235(6):803–13.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Strasberg SM, et al. Proposal for definition and severity, grading of pancreatic anastomosis failure and pancreatic occlusion failure. Surgery. 2007;141(4):420–6.

    Article  PubMed  Google Scholar 

  17. DeLong MR, et al. Publication bias and the under-reporting of complications in the literature: have we dug our own pay-for-performance grave? Plast Reconstr Surg. 2014;134(4S-1):42–3.

    Article  Google Scholar 

  18. Johnston L. Healthcare administration: concept, methodologies, tools and applications: Medical Information Science Reference; 2015.

    Google Scholar 

  19. Bruce J, et al. The measurement and monitoring of surgical adverse events. Health Technol Assess. 2001;5(22):1–194.

    Article  CAS  PubMed  Google Scholar 

  20. Horton R. Surgical research or comic opera: questions, but few answers. Lancet. 1996;347(9007):984–5.

    Article  CAS  PubMed  Google Scholar 

  21. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518–26.

    CAS  PubMed  Google Scholar 

  22. Pillai SB, et al. Complexity- and risk-adjusted model for measuring surgical outcome. Br J Surg. 1999;86(12):1567–72.

    Article  CAS  PubMed  Google Scholar 

  23. Veen MR, et al. Recording and classification of complications in a surgical practice. Eur J Surg. 1999;165(5):421–4; discussion 425.

    Article  CAS  PubMed  Google Scholar 

  24. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009;250(2):177–86.

    Article  PubMed  Google Scholar 

  25. Slankamenac K, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1–7.

    Article  PubMed  Google Scholar 

  26. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Clavien PA, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  28. Chun YS, et al. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg. 2007;11(11):1498–504; discussion 1504–5.

    Article  PubMed  Google Scholar 

  29. Haynes AB, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.

    Article  CAS  PubMed  Google Scholar 

  30. Permpongkosol S, et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol. 2007;177(2):580–5.

    Article  PubMed  Google Scholar 

  31. Sundaram CP, et al. Complications after a 5-year experience with laparoscopic donor nephrectomy: the Indiana University experience. Surg Endosc. 2007;21(5):724–8.

    Article  CAS  PubMed  Google Scholar 

  32. Seely AJ, et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010;90(3):936–42; discussion 942.

    Article  PubMed  Google Scholar 

  33. Petrowsky H, et al. Effects of pentoxifylline on liver regeneration: a double-blinded, randomized, controlled trial in 101 patients undergoing major liver resection. Ann Surg. 2010;252(5):813–22.

    Article  PubMed  Google Scholar 

  34. Oberkofler CE, et al. A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg. 2012;256(5):819–26; discussion 826–7.

    Article  PubMed  Google Scholar 

  35. Vonlanthen R, et al. The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg. 2011;254(6):907–13.

    Article  PubMed  Google Scholar 

  36. Porembka MR, et al. Quantitative weighting of postoperative complications based on the accordion severity grading system: demonstration of potential impact using the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210(3):286–98.

    Article  PubMed  Google Scholar 

  37. Kazaryan AM, Rosok BI, Edwin B. Morbidity assessment in surgery: refinement proposal based on a concept of perioperative adverse events. ISRN Surg. 2013;2013:625093.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kim YW, et al. Long-term outcomes of laparoscopy-assisted distal gastrectomy for early gastric cancer: result of a randomized controlled trial (COACT 0301). Surg Endosc. 2013;27(11):4267–76.

    Article  PubMed  Google Scholar 

  39. Agadzhanov VG, Shulutko AM, Kazaryan AM. Minilaparotomy for treatment of choledocholithiasis. J Visc Surg. 2013;150(2):129–35.

    Article  CAS  PubMed  Google Scholar 

  40. Vollmer CM, et al. Establishing a quantitative benchmark for morbidity in Pancreatoduodenectomy using ACS-NSQIP, the accordion severity grading system, and the postoperative morbidity index. Ann Surg. 2015;261(3):527–36.

    Article  PubMed  Google Scholar 

  41. Reddy S, et al. Timed stair climbing is the single strongest predictor of perioperative complications in patients undergoing abdominal surgery. J Am Coll Surg. 2016;222(4):559–66.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Strasberg SM, Hall BL. Postoperative morbidity index: a quantitative measure of severity of postoperative complications. J Am Coll Surg. 2011;213(5):616–26.

    Article  PubMed  Google Scholar 

  43. Beilan J, et al. The postoperative morbidity index: a quantitative weighing of postoperative complications applied to urological procedures. BMC Urol. 2014;14:1.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Muangkaew P, et al. Outcomes of simultaneous major liver resection and colorectal surgery for colorectal liver metastases. J Gastrointest Surg. 2016;20(3):554–63.

    Article  PubMed  Google Scholar 

  45. Datta J, Vollmer CM Jr. Advances in surgical management of pancreatic diseases. Gastroenterol Clin N Am. 2016;45(1):129–44.

    Article  Google Scholar 

  46. Ratti F, et al. Impact of totally laparoscopic combined management of colorectal cancer with synchronous hepatic metastases on severity of complications: a propensity-score-based analysis. Surg Endosc. 2016;30(11):4934–45.

    Article  PubMed  Google Scholar 

  47. Meffert H, Bolz J. Internationales Marketing-Management. 1998; S.76 ff.76 ff.

    Google Scholar 

  48. Welge MK, Holtbrügge D. Internationales Management: Theorien, Funktionen, Fallstudien. 2006; S.100 ff.100 ff.

    Google Scholar 

  49. Zentes J, Swoboda B, Schramm-Klein H. Internationales Marketing. 2006;S.180.180.

    Google Scholar 

  50. Slankamenac K, et al. The comprehensive complication index a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg. 2014;260(5):757–63.

    Article  PubMed  Google Scholar 

  51. Fretland AA, et al. Open versus laparoscopic liver resection for colorectal liver metastases (the Oslo-CoMet study): study protocol for a randomized controlled trial. Trials. 2015;16:73.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Machado MAC, et al. The laparoscopic Glissonian approach is safe and efficient when compared with standard laparoscopic liver resection: Results of an observational study over 7 years. Surgery. 2016;160(3):643–51.

    Article  PubMed  Google Scholar 

  53. Marsman EM, et al. Pancreatoduodenectomy with colon resection for cancer: a nationwide retrospective analysis. Surgery. 2016;160(1):145–52.

    Article  PubMed  Google Scholar 

  54. Rössler F, et al.. Defining benchmarks for major liver surgery: a multicenter analysis of 5202 living liver donors. Annals of Surgery, 9000. Publish Ahead of Print.

    Google Scholar 

  55. Rosenthal R, et al. Reporting of adverse events in surgical trials: critical appraisal of current practice. World J Surg. 2015;39(1):80–7.

    Article  PubMed  Google Scholar 

  56. Shackleton CR, et al. Morbidity in live liver donors: standards-based adverse event reporting further refined. Arch Surg. 2005;140(9):888–95; discussion 895–6.

    Article  PubMed  Google Scholar 

  57. Satava RM. Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol. 2005;14(4):257–61.

    Article  PubMed  Google Scholar 

  58. Kaafarani HM, et al. Derivation and validation of a novel severity classification for intraoperative adverse events. J Am Coll Surg. 2014;218(6):1120–8.

    Article  PubMed  Google Scholar 

  59. Rosenthal R, et al. Definition and classification of intraoperative complications (CLASSIC): Delphi study and pilot evaluation. World J Surg. 2015;39(7):1663–71.

    Article  PubMed  Google Scholar 

  60. McClusky DA, Smith CD. Design and development of a surgical skills simulation curriculum. World J Surg. 2008;32(2):171–81.

    Article  PubMed  Google Scholar 

  61. Rassweiler JJ, Teber D, Frede T. Complications of laparoscopic pyeloplasty. World J Urol. 2008;26(6):539–47.

    Article  PubMed  Google Scholar 

  62. Kinaci E, et al. Is the classification of intraoperative complications (CLASSIC) related to postoperative course? Int J Surg. 2016;29:171–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Research Grant from the Olga Mayenfisch Foundation to Roxane D. Staiger, MD.

Research Grant from the Liver and Gastrointestinal Disease (LGID) foundation to Pierre-Alain Clavien, MD, PhD.

Author information

Authors and Affiliations

  1. Department of Surgery and Transplantation, University Hospital of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Roxane D. Staiger MD, Diana Vetter MD & Pierre-Alain Clavien MD PhD

Authors
  1. Roxane D. Staiger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diana Vetter MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pierre-Alain Clavien MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierre-Alain Clavien MD PhD .

Editor information

Editors and Affiliations

  1. USC Institute of Urology, University of Southern California, Los Angeles, California, USA

    René Sotelo

  2. Department of Urology, Hospital CIMA, Hermosillo, Sonora, Mexico

    Juan Arriaga

  3. USC Institute of Urology, University of Southern California, Los Angeles, California, USA

    Monish Aron

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Staiger, R.D., Vetter, D., Clavien, PA. (2018). Complication Grading in Surgery. In: Sotelo, R., Arriaga, J., Aron, M. (eds) Complications in Robotic Urologic Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-62277-4_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62277-4_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62276-7

  • Online ISBN: 978-3-319-62277-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation