Surgical Complications and Its Grading: A Literature Review

Manekk, Roshani S; Gharde, Pankaj; Gattani, Rajesh; Lamture, Yashwant

doi:10.7759/cureus.24963

Cited by 18 publications

(22 citation statements)

References 19 publications

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“…These are primarily outcome based with the most severe ending in death, which, fortunately, is rare in hand surgery. Two recent literature reviews have highlighted limited take-up of these classifications in clinical practice, with none involving patients in their development (Balvardi et al., 2021; Manekk et al., 2022). There appears to be no published literature specifically grading complications in hand surgery.…”

Section: Grading/classification Of Errors and Adverse Outcomesmentioning

confidence: 99%

Surgical complications: errors and adverse events

Giddins

2024

J Hand Surg Eur Vol

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Complications are a recognized hazard of surgery. The term is confusing; it has multiple meanings, including surgical error and adverse surgical outcomes. I propose the latter two terms are used. Grading of ‘complications’ is difficult but made easier by grading errors and outcomes separately, though they are not always linked. The exact grades are not established. Error avoidance requires efforts at a personal (surgeon) level, including training, learning and preparation, and at a systems level. Understanding human factors is important. The perspective of patients about adverse outcomes is not well understood. There is evidence that, unsurprisingly, patient perspectives may be different to surgeon perspectives. There are a range of surgeon responses to error and adverse outcomes; many are negative. These need to be understood better in order to protect patients and surgeons in the immediate aftermath and in the potentially prolonged ‘recovery time’, both for patients and surgeons. Level of evidence: V

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Section: Grading/classification Of Errors and Adverse Outcomesmentioning

confidence: 99%

Surgical complications: errors and adverse events

Giddins

2024

J Hand Surg Eur Vol

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“…As the number of worldwide surgeries increases, 1,2 there is a growing demand for improvements in health care delivery and surgical quality. 3 The accurate and uniform assessment and grading of perioperative AE severity are essential to ensure the ability to compare surgical procedures and study outcomes, and the usage of common terminology could allow large-scale data synthesis to inform clinical decision-making. [4][5][6] A lack of a standardized perioperative AE grading system likely impairs our understanding of the impact these events have on perioperative morbidity.…”

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confidence: 99%

“…[4][5][6] A lack of a standardized perioperative AE grading system likely impairs our understanding of the impact these events have on perioperative morbidity. 3 Such a standardized assessment tool may also be relevant for early allocation to different postoperative treatment and follow-up strategies and for learning purposes such as defining procedure-related proficiency. The grading of postoperative adverse events is now standardized in large part due to efforts pioneered by Strasberg et al and Clavien et al to produce a validated, cross-specialty applicable postoperative complication severity grading system.…”

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confidence: 99%

“…Despite proper surgical checklists and surgical expertise, perioperative adverse events (AEs) can occur. As the number of worldwide surgeries increases, 1,2 there is a growing demand for improvements in health care delivery and surgical quality 3 …”

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confidence: 99%

“…The accurate and uniform assessment and grading of perioperative AE severity are essential to ensure the ability to compare surgical procedures and study outcomes, and the usage of common terminology could allow large-scale data synthesis to inform clinical decision-making 4–6 . A lack of a standardized perioperative AE grading system likely impairs our understanding of the impact these events have on perioperative morbidity 3 . Such a standardized assessment tool may also be relevant for early allocation to different postoperative treatment and follow-up strategies and for learning purposes such as defining procedure-related proficiency.…”

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Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis

et al. 2023

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Introduction:The accurate assessment and grading of adverse events (AE) is essential to ensure comparisons between surgical procedures and outcomes. The current lack of a standardized severity grading system may limit our understanding of the true morbidity attributed to AEs in surgery. The aim of this study is to review the prevalence in which intraoperative adverse event (iAE) severity grading systems are used in the literature, evaluate the strengths and limitations of these systems, and appraise their applicability in clinical studies. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. PubMed, Web of Science, and Scopus were queried to yield all clinical studies reporting the proposal and/or the validation of iAE severity grading systems. Google Scholar, Web of Science, and Scopus were searched separately to identify the articles citing the systems to grade iAEs identified in the first search. Results: Our search yielded 2957 studies, with 7 studies considered for the qualitative synthesis. Five studies considered only surgical-/interventional iAEs, while 2 considered both surgical/interventional and anesthesiologic iAEs. Two included studies validated the iAE severity grading system prospectively. A total of 357 citations were retrieved, with an overall self/nonself-citation ratio of 0.17 (53/304). The majority of citing articles were clinical studies (44.1%). The average number of citations per year was 6.7 citations for each classification/severity system, with only 2.05 citations/year for clinical studies. Of the 158 clinical studies citing the severity grading systems, only 90 (56.9%) used them to grade the iAEs. The appraisal of applicability (mean%/median%) was below the 70% threshold in 3 domains: stakeholder involvement (46/47), clarity of presentation (65/67), and applicability (57/56). Conclusion: Seven severity grading systems for iAEs have been published in the last decade. Despite the importance of collecting and grading the iAEs, these systems are poorly adopted, with only a few studies per year using them. A uniform globally implemented severity grading system is needed to produce comparable data across studies and develop strategies to decrease iAEs, further improving patient safety.

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Longitudinal Comparative Analysis of Complications and Subsequent Interventions Following Stand-Alone Interspinous Spacers, Open Decompression, or Fusion for Lumbar Stenosis

2023

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Introduction For individuals with lumbar spinal stenosis (LSS), minimally invasive procedures such as an interspinous spacer device without decompression or fusion (ISD) or open surgery (i.e., open decompression or fusion) may relieve symptoms and improve functions when patients fail to respond to conservative therapies. This research compares longitudinal postoperative outcomes and rates of subsequent interventions between LSS patients treated with ISD and those with open decompression or fusion as their first surgical intervention. Methods This retrospective, comparative claims analysis identified patients age ≥ 50 years with LSS diagnosis and with a qualifying procedure during 2017–2021 in the Medicare database which includes healthcare encounters in inpatient and outpatient settings. Patients were followed from the qualifying procedure until end of data availability. The outcomes assessed during the follow-up included subsequent surgical interventions, including subsequent fusion and lumbar spine surgeries, long-term complications, and short-term life-threatening events. Additionally, the costs to Medicare during a 3-year follow-up were calculated. Cox proportional hazards, logistic regression, and generalized linear models were used to compare outcomes and costs, adjusted for baseline characteristics. Results A total of 400,685 patients who received a qualifying procedure were identified (mean age 71.5 years, 50.7% male). Compared to ISD patients, patients receiving open surgery (i.e., decompression and/or fusion) were more likely to have a subsequent fusion [hazard ratio (HR), 95% confidence intervals (CI): 1.49 (1.17, 1.89)–2.54 (2.00, 3.23)] or other lumbar spine surgery [HR (CI): 3.05 (2.18, 4.27)–5.72 (4.08, 8.02)]. Short-term life-threatening events [odds ratio (CI): 2.42 (2.03, 2.88)–6.36 (5.33, 7.57)] and long-term complications [HR (CI): 1:31 (1.13, 1.52)–2.38 (2.05, 2.75)] were more likely among the open surgery cohorts. Adjusted mean index costs were lowest for decompression alone (US$7001) and highest for fusion alone ($33,868). ISD patients had significantly lower 1-year complication-related costs than all surgery cohorts and lower 3-year all-cause costs than fusion cohorts. Conclusions ISD resulted in lower risks of short- and long-term complications and lower long-term costs than open decompression and fusion surgeries as a first surgical intervention for LSS. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02562-6.

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Surgical Complications and Its Grading: A Literature Review

Cited by 18 publications

References 19 publications

Surgical complications: errors and adverse events

Surgical complications: errors and adverse events

Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis

Longitudinal Comparative Analysis of Complications and Subsequent Interventions Following Stand-Alone Interspinous Spacers, Open Decompression, or Fusion for Lumbar Stenosis

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