REPORTING AND GRADING OF COMPLICATIONS AFTER UROLOGIC SURGICAL PROCEDURES: AN AD HOC EAU GUIDELINES PANEL ASSESSMENT AND RECOMMENDATIONS

Česká verzia

Authors: D. Mitropoulos ¹; W. Artibani ²; M. Graefen ³; M. Remzi ⁴; M. Roupręt ⁵; M. Truss ⁶
Authors place of work: 1st Department of Urology, University of Athens Medical School, Athens, Greece ¹; Department of Biomedical and Surgical Sciences, Urology Clinic, University of Verona, Verona, Italy ²; Martini-Clinic, Prostate Cancer Centre, University Hamburg-Eppendorf, Hamburg, Germany ³; Department of Urology, LandesklinikumKorneuburg, Korneuburg, Austria ⁴; Academic Department of Urology, Hospital Pitié-Salpétriére, Assistance PubliqueHopitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France ⁵; Department of Urology, Klinikum Dortmund GmbH, Dortmund, Germany ⁶
Published in the journal: Urol List 2012; 10(1): 75-84

Summary

Context:
The incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology.

Objective:
To review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes.

Evidence acquisition:
Standardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999–2000 and 2009–2010. Data identification for the systematic assessment of the Clavien-Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms.

Evidence synthesis:
The systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien-Dindo system. The latter system was not properly used in 72 papers (35.3%).

Conclusions:
Uniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria. Take Home Message: Although there is a demonstrable increase in the awareness and use of standardised reporting of complications in the literature, no standard guidelines or criteria exist for reporting surgical complications in the area of urology. The authors present a series of practical recommendations for reporting and grading complications that could help to improve patient care and the quality of scientific publications.

Key words:
postoperative complications, urology, reporting, grading, Clavien-Dindo, EAU, recommendations, standardization

Zdroje

1. Bertges DJ, Shackford AR, Cloud AK et al. Toward optimal recording of surgical complications: concurrent tracking compared to the discharge data set. Surgery 2007; 141(1): 19–31.

2. Dindo D, Hahnloser D, Clavien PA. Quality assessment in surgery: riding a lame horse. Ann Surg 2010; 251(4): 766–771.

3. Fink AS, Campbell DA Jr., Mentzer RM Jr. et al. The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg 2002; 236(3): 344–353.

4. Clavien PA, Dindo D. Surgeon's intuition: is it enough to assess patients’ surgical risk? World J Surg 2007; 31(10): 1909–1911.

5. Sokol DK, Wilson J. What is a surgical complication? World J Surg 2008; 32(6): 942–944.

6. Veen MR, Lardenoye JW, Kastelein GW et al. Recording and classification of complications in a surgical practice. Eur J Surg 1999; 165(5): 421–424.

7. Dindo D, Clavien PA. What is a surgical complication? World J Surg 2008; 32(6): 939–941.

8. Xylinas E, Durand X, Ploussard G et al. Evaluation of combined oncologic and functional outcomes after robotic-assisted laparoscopic extraperitoneal radical prostatectomy. Trifecta rate of achieving continence, potency and cancer control. Urol Oncol 2011 [Epub ahead of print].

9. Martin RC II, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg 2002; 235(6): 803–813.

10. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992; 111(5): 518–526.

11. 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(2): 205–213.

12. Donat SM. Standards for surgical complication reporting in urologic oncology: time for a change. Urology 2007; 69(2): 221–225.

13. Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250(2): 187–196.

14. Kooby DA, Fong Y, Suriawinata A et al. Impact of steatosis on periooperative outcome following hepatic resection. J GastrointestSurg 2003; 7(8): 1034–1043.

15. Strasberg SM, Linehan DC, Hawkins WG. The Accordion Severity Grading System of surgical complications. Ann Surg 2009; 250(2): 177–186.

16. Trotti A, Colevas D, Setser A et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Rad Oncol 2003; 13(3): 176–181.

17. Haylen BT, Freeman RM, Swift SE et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implant tapes) and grafts in female pelvic floor. Neurourol Urodyn 2011; 30(1): 2–12.

18. Bruce J, Russell EM, Mollison J et al. The measurement and monitoring of surgical adverse events. Health Technol Assess 2001; 5(22): 1–194.

19. Graefen M. The modified Clavien system: a plea for a standardized reporting system for surgical complications. Eur Urol 2010; 57(3): 387–389.

20. Schroeck FR, Krupski TL, Sun L et al. Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy. Eur Urol 2008; 54(4): 785–793.

21. Sanda MG, Dunn RL, Michalski J et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008; 358(12): 1250–1261.

22. Litwin MS, Hays RD, Fink A et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 1995; 273(2): 129–135.

23. Steinsvik EA, Fosså SD, Axcrona K et al. Do perceptions of adverse events differ between patients and physicians? Findings from a randomized, controlled trial of radical treatment for prostate cancer. J Urol 2010; 184(2): 525–531.

24. Gunnarsson U, Seligsolin E, Jestin P. Registration and validity of surgical complications in colorectal cancer registry. Br J Surg 2003; 90(4): 454–459.

25. Rodkey GV, Itani KMF. Evaluation of healthcare quality: a tale of three giants. Am J Surg 2009; 198 (Suppl 5A): S3–S8.

26. Bilimoria KY, Cohen ME, Igraham AM et al. Effect of postdischarge morbidity and mortality on comparisons of hospital surgical quality. Ann Surg 2010; 252(1): 183–190.

27. Morris AM, Baldwin LM, Matthews B et al. Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 2007; 245(1): 73–79.