Variable impact of complications in general surgery: a prospective cohort study

Background: 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. Methods: We conducted a prospective observational cohort study to evaluate consequences and severity of complications in surgical practice. All recorded complications of patients admitted to our hospital between June 1, 2005, and Dec. 31, 2007, were prospectively recorded in an electronic database. Complications were classified according to the system of the Trauma Registry of the American College of Surgeons. We graded the severity of complications according to the system proposed by Clavien and colleagues, and the consequences of each complication were registered. Results: During the study period, 3418 complications were recorded; consequences and severity were recorded in 89% of them. Of 3026 complications, 987 (33%) were grade I, 781 (26%) were grade IIa, 1020 (34%) were grade IIb, 150 (5%) were grade III and 88 (3%) were grade IV. The consequences and severity of identically registered complications showed a large degree of variation, best illustrated by wound infections, which were grade I in 50%, grade IIa in 22%, grade IIb in 28% and grade III and IV in 0.3% of patients. Conclusion: Severity should be routinely presented when reporting complications in clinical practice and surgical research papers to adequately compare quality of care and results of clinical trials. Contexte : En chirurgie, il importe de consigner les complications puisqu'elles servent de mesure des resultats et d'indicateurs de la qualite des soins. Peu d'etudes ont evalue les variations de la gravite et des consequences des complications. Selon notre hypothese, les complications ont des consequences de nature et d'intensite tres diverses. Methodes : Nous avons effectue une etude de cohorte d'observation prospective afin de mesurer les consequences et la gravite des complications dans la pratique chirurgicale. Toutes les complications rapportees chez les patients admis dans notre hopital entre le 1 juin 2005 et le 31 decembre 2007 ont ete saisies de maniere prospective dans une base de donnees electronique puis on les a classees dans l'une ou l'autre des categories du Registre des traumatismes de l'American College of Surgeons. Nous en avons mesure la gravite en nous inspirant du systeme propose par Clavien et ses collaborateurs et nous avons consigne les consequences de chaque complication. Resultats : Au cours de la periode de l'etude, 3418 complications ont ete recensees; les consequences et la gravite de 89 % d'entre elles ont ete notees. Sur 3026 complications, 987 (33 %) etaient de grade I, 781 (26 %) etaient de grade IIa, 1020 (34 %) etaient de grade IIb, 150 (5 %) etaient de grade III et 88 (3 %), de grade IV. Les consequences et la gravite des complications d'une meme categorie ont montre un fort degre de variation, comme en temoignent le plus eloquemment les infections de plaies, qui etaient de grade I dans 50 % des cas, de grade IIa dans 22 % des cas, de grade IIb dans 28 % des cas et de grade III et IV dans 0,3 % des cas. Conclusion : Dans la pratique clinique et dans les comptes rendus de recherche, il faut indiquer la gravite des complications chirurgicales pour pouvoir effectuer une comparaison valide de la qualite des soins et des resultats des essais cliniques.
Complications in surgery are an important cause of morbidity and mortality and may result in an increased length of stay in hospital, repeat surgery, additional medical treatment, legal issues and [...]