Perception of surgical complications among patients, nurses and physicians: a prospective cross-sectional survey

Abstract

BackgroundSeveral scores grade the severity of post-operative complications but it is unclear whether such scores truly reflect the perception of patients and practicing nurses and physicians.Study Design227 patients, 143 nurses and 245 physicians independently rated the severity of 30 common post-operative complications on a numerical analogue scale from 0 (not severe at all) to 100 (extremely severe) while being blinded towards the Clavien-Dindo classification. We considered a difference in ratings of >10 to be clinically important in distinguishing between grades of severity and groups. We evaluated the level of reproducibility of responses by calculating intraclass correlation coefficients (ICC) and compared scores across severity grades and between groups using the generalized estimating equations.ResultsReproducibility of the ratings was good for all three groups (ICCpatients 0.71 (95%-CI 0.64-0.76), ICCnurses 0.83 (0.78-0.87) and ICCphysicians 0.87 (0.83-0.90)). The participants' perceptions of the severity of complications reflected the Clavien-Dindo classification (median of grade I: 20 (IQR 10-30), grade II: 40 (31.3-52.5), grade IIIa: 50 (40-60), grade IIIb: 70 (60-75), grade IVa: 85 (80-90) and grade IVB: 95 (90-100)). Although patients' perception differed significantly from those of physicians (average difference -8.7 (95%-CI -10.4 to -6.9, p < 0.001) and nurses (difference -2.8 (-4.8 to -0.8, p = 0.007) they did not reach our thresholds for clinical importance.ConclusionsThe severity of post-operative complications is perceived similarly by patients, nurses and physicians and reflects the Clavien-Dindo classification well. Our results support the use of Clavien-Dindo classification system as part of the shared or informed decision making process.

The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien–Dindo classification in radical gastric cancer surgery

“…For feasible applications, it can be easily assessed by the CCI calculator available at website (http://www.assessur gery.com). From our data, integrated complication data for each patient were entered into the CCI calculator, and CCI values were computed and summed for analysis [12,17].…”

The Comprehensive Complication Index

“…[16][17][18] The CCI was finally calculated as the sum of all complications that are weighted for their severity by patients and physicians. 8,19 The final formula yields a score from 0 (no complication) to 100 (death). 8 The CCI can easily be calculated online by free access at www.assessurgery.com.…”

Correspondence

“…Unquestionably, we agree on his main message that patients and their perspective must be the focus of surgical outcome improvement. This does not deviate from our proposed benchmarking approach on surgical outcome, acknowledging that patients' perception of surgical outcome often differ from the surgeons' viewpoint,.…”