RSS-Feed abonnieren
DOI: 10.1055/s-0043-1764454
Discussing Complications after Surgery Consists of Multiple Dimensions
![](https://www.thieme-connect.de/media/ejps/202302/lookinside/thumbnails/10-1055-s-0043-1764454_v33n2editorial-1.jpg)
Surgeons are obligated to assure the highest quality of care for their patients, and part of this process is regular in-house audits to review their results and outcomes.[1] [2] Complications must be reported, documented, and discussed, to collectively learn from adverse events and to prevent them in the future.[3] [4] Multiple recent analyses provide information on the beneficial aspects of systematic prospective assessment of adverse events in the surgical management of patients to obtain the real incidence and extent of complications.[5] [6] [7] This strategy is the keystone to prepare for (serious) adverse events for the morbidity and mortality conferences, which, if necessary, result in amendments of the standard operating procedures (SOP) based on the discussions. While numerous projects focus on the patients' outcome after (serious) adverse events, the surgeon's perspective and their coping with those events is still neglected in the literature.[8]
Furthermore, in the time of global scientific exchange, surgeons are interested in comparing their results with international expert centers. Therefore, uniform reporting of adverse events in the in- and out-patient care of surgical patients was aimed at early and finally resulted in the multidisciplinary OUTCOME4MEDICINE consensus conference in Zurich in 2022.[9] In an extraordinary approach of inviting various stakeholders, from clinicians, insurance to patients' representatives, benchmarks for reporting the outcome of general surgery were defined. The results of the conference are now made available to all as an article in the esteemed Journal of Nature Medicine.
While the meeting was the climax of a decade-long development[10] [11] [12] in general surgery, starting with the definition of complications and the implementation of severity grading systems, those milestones have so far been ignored in pediatric surgical literature.
The purpose of this review block, in a joint approach of pediatric and general surgical working groups, is to give a broad readership of pediatric surgeons an overview on current developments in the processing and discussion of complications in surgical patients, highlighting drawbacks in the pediatric surgical literature and providing the readership with guidelines for their clinical and academic routine.
de Vos et al[13] present practical guidelines for the organization and process of morbidity and mortality conferences that should be implemented into clinical practice.
Kalt et al[14] provide the readers with an overview of classifications of adverse events in the intra- and postoperative management of adult surgical patients, giving additional insight into the digitalization of documentation.
Madadi-Sanjani et al[15] give an overview on current scientific practices of the assessment and classification of adverse events in the pediatric surgical literature, concluding practical guidelines for future application.
Himidan et al present the psychological aspects of dealing with a complication from a surgeon's perspective.
We appreciate this issue of the European Journal of Pediatric Surgery and hope that it will contribute to promoting the topic among pediatric surgeons all over the globe.
Publikationsverlauf
Artikel online veröffentlicht:
17. März 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Chung KC, Kotsis SV. Complications in surgery: root cause analysis and preventive measures. Plast Reconstr Surg 2012; 129 (06) 1421-1427
- 2 Brennan TA, Gawande A, Thomas E, Studdert D. Accidental deaths, saved lives, and improved quality. N Engl J Med 2005; 353 (13) 1405-1409
- 3 Lazzara EH, Salisbury M, Hughes AM, Rogers JE, King HB, Salas E. The morbidity and mortality conference: opportunities for enhancing patient safety. J Patient Saf 2022; 18 (01) e275-e281
- 4 Giesbrecht V, Au S. Morbidity and mortality conferences: a narrative review of strategies to prioritize quality improvement. Jt Comm J Qual Patient Saf 2016; 42 (11) 516-527
- 5 Forster AJ, Huang A, Lee TC, Jennings A, Choudhri O, Backman C. Study of a multisite prospective adverse event surveillance system. BMJ Qual Saf 2020; 29 (04) 277-285
- 6 Backman C, Forster AJ, Vanderloo S. Barriers and success factors to the implementation of a multi-site prospective adverse event surveillance system. Int J Qual Health Care 2014; 26 (04) 418-425
- 7 Sethi MVA, Zimmer J, Ure B, Lacher M. Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery. J Pediatr Surg 2016; 51 (04) 630-633
- 8 Helo S, Moulton CE. Complications: acknowledging, managing, and coping with human error. Transl Androl Urol 2017; 6 (04) 773-782
- 9 Consensus Conference – OUTCOME4MEDICINE. USZ. Accessed February 21, 2023, at: https://www.usz.ch/veranstaltung/consensus-conference-outcome4medicine/
- 10 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
- 11 Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013; 258 (01) 1-7
- 12 Dell-Kuster S, Gomes NV, Gawria L. et al. Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. BMJ 2020; 370: m2917
- 13 de Vos MS, Verhagen MJ, Hamming JF. The morbidity and mortality conference: a century-old practice with ongoing potential for future improvement. Eur J Pediatr Surg 2023 (e-pub ahead of print). DOI: 10.1055/s-0043-1760836.
- 14 Kalt F, Mayr H, Gero D. Classification of adverse events in adult surgery. Eur J Pediatr Surg 2023; (e-pub ahead of print). DOI: 10.1055/s-0043-1760821.
- 15 Madadi-Sanjani O, Brendel J, Kuebler JF, Ure BM. Definition, documentation, and classification of complications in pediatric surgical literature—a plea for standardization. Eur J Pediatr Surg 2023; (e-pub ahead of print). DOI: 10.1055/s-0043-1760835.