What is a Surgical Complication?

Sokol, Daniel K; Wilson, James

doi:10.1007/s00268-008-9471-6

Cited by 146 publications

(109 citation statements)

References 7 publications

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“…A surgical complication can be defined as "any deviation from the ideal postoperative course that is not inherent in the procedure and does not comprise a failure to cure" or "a surgical complication is any undesirable, unintended, and direct result of surgery affecting the patient which would not have occurred had the surgery gone as well as could reasonably be hoped." 19 A surgical complication should be discerned from sequelae, which are "conditions that are inherent in the procedure, and that thus will inevitably occur (such as scar formation or the inability to walk after an amputation)." 19 A thin line often exists between complications and sequelae, and these 2 events may even overlap.…”

Section: What Is a Surgical Complication?mentioning

confidence: 99%

“…19 A surgical complication should be discerned from sequelae, which are "conditions that are inherent in the procedure, and that thus will inevitably occur (such as scar formation or the inability to walk after an amputation)." 19 A thin line often exists between complications and sequelae, and these 2 events may even overlap. Hemiparesis experienced after resection of a temporal tumor or a medulloblastoma is indeed a complication.…”

Section: What Is a Surgical Complication?mentioning

confidence: 99%

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Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

Lindert

Delye

Leonardo

2014

PED

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Object The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care. Methods The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded. Results Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders. Conclusions The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).

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Section: What Is a Surgical Complication?mentioning

confidence: 99%

Section: What Is a Surgical Complication?mentioning

confidence: 99%

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

Lindert

Delye

Leonardo

2014

PED

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“…18,39 The issue of how to define the negative results of surgical procedures were initially a matter of debate in the field of general surgery and recently in the neurosurgical community. 17,18,23,31,35 More than 20 years ago, general surgeons defined a complication as any morbid event occurring "as a result of the procedure, during the performance or recovery from the procedure, which causes deviations from the ideal course and tends to impair or delay complete recovery and induces changes in the management of the patient." 10 The same authors brought up another pivotal concept: the complexity of surgery, which arises from the preoperative conditions and is defined as the risk to incur in postoperative complications and negative outcomes.…”

mentioning

confidence: 99%

Predicting functional impairment in brain tumor surgery: the Big Five and the Milan Complexity Scale

Ferroli¹,

Broggi²,

Schiavolin³

et al. 2015

FOC

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OBJECT The Milan Complexity Scale—a new practical grading scale designed to estimate the risk of neurological clinical worsening after performing surgery for tumor removal—is presented. METHODS A retrospective study was conducted on all elective consecutive surgical procedures for tumor resection between January 2012 and December 2014 at the Second Division of Neurosurgery at Fondazione IRCCS Istituto Neurologico Carlo Besta of Milan. A prospective database dedicated to reporting complications and all clinical and radiological data was retrospectively reviewed. The Karnofsky Performance Scale (KPS) was used to classify each patient’s health status. Complications were divided into major and minor and recorded based on etiology and required treatment. A logistic regression model was used to identify possible predictors of clinical worsening after surgery in terms of changes between the preoperative and discharge KPS scores. Statistically significant predictors were rated based on their odds ratios in order to build an ad hoc complexity scale. For each patient, a corresponding total score was calculated, and ANOVA was performed to compare the mean total scores between the improved/unchanged and worsened patients. Relative risk (RR) and chi-square statistics were employed to provide the risk of worsening after surgery for each total score. RESULTS The case series was composed of 746 patients (53.2% female; mean age 51.3 ± 17.1). The most common tumors were meningiomas (28.6%) and glioblastomas (24.1%). The mortality rate was 0.94%, the major complication rate was 9.1%, and the minor complication rate was 32.6%. Of 746 patients, 523 (70.1%) patients improved or remained unchanged, and 223 (29.9%) patients worsened. The following factors were found to be statistically significant predictors of the change in KPS scores: tumor size larger than 4 cm, cranial nerve manipulation, major brain vessel manipulation, posterior fossa location, and eloquent area involvement (Nagelkerke R2 = 0.286). A grading scale was obtained with scores ranging between 0 and 8. Worsened patients showed mean total scores that were significantly higher than the improved/unchanged scores (3.24 ± 1.55 vs 1.47 ± 1.58; p < 0.001). Finally, a grid was developed to show the risk of worsening after surgery for each total score: scores higher than 3 are suggestive of worse clinical outcome. CONCLUSIONS Through the evaluation of the 5 aforementioned parameters—the Big Five—the Milan Complexity Scale enables neurosurgeons to estimate the risk of a negative clinical course after brain tumor surgery and share these data with the patient. Furthermore, the Milan Complexity Scale could be used for research and educational purposes and better health system management.

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“…8,9,12 Up to now, the lack of a uniformly adopted system for classifying severity of complications has hampered comparability of the events reported in the surgical literature, although the modified Clavien-Dindo system 11 is used with increasing frequency. The results of our study signify the need for a uniform grading system for complications, especially if these are used as outcome measures.…”

Section: Discussionmentioning

confidence: 99%

“…Although efforts are being made to improve quality of care by means of uniform registration of adverse events and mortality, 7 unfortunately, in many countries, comparison of outcomes among health care providers is hampered by the lack of a clear definition of complications. 8,9 Moreover, when comparing outcomes of treatment, the severity of complications is usually not taken into account; however, differences in recorded severity may reveal differences in quality of care and subsequently provide opportunities for improving quality of care.…”

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confidence: 99%

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

et al. 2012

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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.

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What is a Surgical Complication?

Cited by 146 publications

References 7 publications

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

Predicting functional impairment in brain tumor surgery: the Big Five and the Milan Complexity Scale

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

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