Quality of Complication Reporting in the Surgical Literature

Abstract

ObjectiveTo identify 10 critical elements of accurate and comprehensive reports of surgical complications. Summary Background DataDespite a venerable tradition of weekly morbidity and mortality conferences, inconsistent complication reporting is common in the surgical literature. MethodsAn analysis of articles reporting short-term outcomes after pancreatectomy, esophagectomy, and hepatectomy was performed. Randomized clinical trials (RCTs) published from 1975 to 2001 and retrospective series of more than 100 patients published from 1990 to 2001 were reviewed. ResultsA total of 119 articles reporting outcomes in 22,530 patients were analyzed. This included 42 RCTs and 77 retrospective series. Of the 10 criteria developed, no articles met all criteria; 2% met 9 criteria, 38% 7 or 8, 34% 5 or 6, 40% 3 or 4, and 12% 1 or 2. Outpatient information (22% of articles), definitions of complications provided (34% of articles), severity grade used (20% of articles), and risk factors included in analysis (29% of articles) were the most commonly unmet quality reporting criteria. Type of study (RCT vs. retrospective), site of institution (U.S. vs. non-U.S.) and journal (U.S. vs. non-U.S.) did not influence the quality of complication reporting. ConclusionsShort-term surgical outcomes are routinely included in the data reported in the surgical literature. This is often used to show improvements over time or to assess the impact of therapeutic changes on patient outcome. The inconsistency of reporting and the lack of accepted principles of accrual, display, and analysis of complication data argue strongly for the creation and generalized use of standards for reporting this information.Although an array of short-term postoperative outcomes such as operative time, estimated blood loss, blood transfusion, length of hospital stay, time to return to work, or hospital charges have been reported, death and complication rates remain the most frequently measured and reported endpoints. With their preeminence as surgical outcome measures, they are often the sole data provided as a means of comparing surgical techniques or perioperative management decisions. Complication reports within both hospitals and the medical literature thus deserve consistency and clarity in reporting.There have been more than 11 million articles annotated in the Index Medicus since 1966, and better than 8,000 new publications are added each week. With this explosion of publications in the medical literature, variability in the quality of the reports inevitably occurs. The ability of the physician to discern these differences in quality requires considerable time, expertise, and insight. This places an increasing burden of responsibility on the journal editors and reviewers of submitted articles to make consistent recommendations to potential authors that will ensure that improved reports meeting minimal standards will be published. This is particularly important for those endpoints, such as surgical complications, that are so frequently portrayed as the prime rea...

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