Proposed classification of complications of surgery with examples of utility in cholecystectomy.
Proposed classification of complications of surgery with examples of utility in cholecystectomy.
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DOI：
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发表时间：
1992-05
期刊：
影响因子：
3.8
通讯作者：
P. Clavien;J. Sanabria;S. Strasberg
中科院分区：
文献类型：
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作者：
P. Clavien;J. Sanabria;S. Strasberg
由于缺乏对阴性结果的统一报告，因此难以解释手术文献。我们试图通过区分并发症、后遗症和失败来定义和分类不良结局。手术引起的并发症和后遗症，给基础疾病增加了新的问题。然而，并发症是非手术固有的非预期事件，而后遗症是手术固有的。失败是指未实现程序目的的事件。我们提出了一个基于四个等级的并发症分类：I级并发症是从理想的术后病程的改变，不危及生命，没有持久的残疾。这种级别的并发症只需要床旁操作，不会显著延长住院时间。II级并发症可能危及生命，但无残留残疾。在II级并发症中，根据侵入性手术的要求进行细分。III级并发症是指具有残留残疾的并发症，包括器官切除或持续存在危及生命的疾病。最后，IV级并发症是由于并发症导致的死亡。为了说明分类的相关性，我们回顾了650例择期胆囊切除术。确定并发症发生的危险因素，并将其分类用于分析改良APACHE II作为术前预后评分的价值。两人都支持拟议分类的相关性。这种分类的优点是（1）提高报告结果的一致性，（2）能够比较单个中心两个不同时间段的结果，（3）能够比较不同中心之间的手术结果，（4）能够比较手术与非手术措施的结果，（5）能够进行充分的荟萃分析，（6）识别客观术前危险因素的能力，和（7）建立术前预后评分的能力。
Lack of uniform reporting of negative outcomes makes interpretation of surgical literature difficult. We attempt to define and classify negative outcomes by differentiating complications, sequelae, and failures. Complications and sequelae result from procedures, adding new problems to the underlying disease. However, complications are unexpected events not intrinsic to the procedure, whereas sequelae are inherent to the procedure. Failures are events in which the purpose of the procedure is not fulfilled. We propose a classification of complications based on four grades: Grade I complications are alterations from the ideal postoperative course, non-life-threatening, and with no lasting disability. Complications of this grade necessitate only bedside procedures and do not significantly extend hospital stay. Grade II complications are potentially life-threatening but without residual disability. Within grade II complications a subdivision is made according to the requirement for invasive procedures. Grade III complications are those with residual disability, including organ resection or persistence of life-threatening conditions. Finally, grade IV complications are deaths as a result of complications. To illustrate the relevance of the classification, we reviewed 650 cases of elective cholecystectomy. Risk factors for development of complications were determined, and the classification was also used to analyze the value of a modified APACHE II as a preoperative prognostic score. Both supported the relevance of the proposed classification. The advantages of such a classification are (1) increased uniformity in reporting results, (2) the ability to compare results of two distinct time periods in a single center, (3) the ability to compare results of surgery between different centers, (4) the ability to compare results of surgical versus nonsurgical measures, (5) the ability to perform adequate metaanalysis, (6) the ability to identify objective preoperative risk factors, and (7) the ability to establish preoperative prognostic scores.