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Eur J Pediatr Surg 2023; 33(02): 120-128
DOI: 10.1055/s-0043-1760821
Review Article

Classification of Adverse Events in Adult Surgery

Fabian Kalt
1   Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
,
Hemma Mayr
1   Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
,
Daniel Gero 
1   Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
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Abstract

Successful surgery combines quality (achievement of a positive outcome) with safety (avoidance of a negative outcome). Outcome assessment serves the purpose of quality improvement in health care by establishing performance indicators and allowing the identification of performance gaps. Novel surgical quality metric tools (benchmark cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes in a subgroup of well-defined low-risk patients, with the aim of setting realistic and best achievable goals for surgeons and centers, as well as supporting unbiased comparison of surgical quality between centers and periods of time. Validated classification systems have been deployed to grade adverse events during the surgical journey: (1) the ClassIntra classification for the intraoperative period; (2) the Clavien–Dindo classification for the gravity of single adverse events; and the (3) Comprehensive Complication Index (CCI) for the sum of adverse events over a defined postoperative period. The failure to rescue rate refers to the death of a patient following one or more potentially treatable postoperative adverse event(s) and is a reliable proxy of the institutional safety culture and infrastructure. Complication assessment is undergoing digital transformation to decrease resource-intensity and provide surgeons with real-time pre- or intraoperative decision support. Standardized reporting of complications informs patients on their chances to realize favorable postoperative outcomes and assists surgical centers in the prioritization of quality improvement initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the enhancement of clinical standards.

Keywords

surgical outcomes - complications - classification - benchmarks - textbook outcomes


Publication History

Received: 06 November 2022

Accepted: 15 November 2022

Article published online:
31 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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