Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey
Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey
复制标题
DOI：
10.1097/01.sla.0000133083.54934.ae
复制
发表时间：
2004-08-01
影响因子：
9
通讯作者：
Clavien, PA
中科院分区：
文献类型：
--
作者：
Dindo, D;Demartines, N;Clavien, PA
目的：虽然质量评估越来越受到关注，但对于如何定义和分级术后并发症仍没有达成共识。这一缺点阻碍了不同的中心和治疗结果之间的数据比较，并随着时间的推移.Patients和方法：一个分类的并发症发表的作者之一，在1992年进行了严格的重新评估和修改，以增加其准确性和可接受性的外科社区。修改主要集中在报告危及生命和永久致残并发症的方式上。新的分级系统仍然主要依赖于用于治疗并发症的疗法。该分类在我们机构接受择期普外科手术的6336例患者队列中进行了测试。结果：新的分级系统与手术复杂性（P < 0.0001）和住院时间（P <0.0001）显著相关。来自世界各地10个不同中心的144名外科医生接受了不同程度的培训，并返回了调查。90%的病例报告被正确评分。该分类被认为是简单的（92%的受访者），可重复的（91%），合乎逻辑的（92%），有用的（90%）和全面的（89%）。这两个问卷的答案是不依赖于原产地的答复和培训水平的surgeers.Conclusions：新的并发症分类似乎是可靠的，并可能代表一个令人信服的工具，在世界各地的手术质量评估。
Objective: Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time.Patients and Methods: A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide.Results: The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons.Conclusions: The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.