Why do complications of gastrointestinal disease and procedures come as serial rather than singular events?
1Gastroenterology Section, Portland VA Medical Center, Oregon Health & Science University, Portland, OR 97239, USA. sonnenbe@ohsu.edu
Background:
It often appears as if complications arising from gastrointestinal disease and interventional procedures come in 'series' and 'cluster' in individual patients.
Aim:
The aim of this study was to analyse the clustering of complications in terms of stochastic modelling and Markov chains.
Methods:
A patient with gastrointestinal disease is simulated to move along either a 'bad track' associated with multiple consecutive complications or a 'good track' free of complications, the transitions within each track and between the two tracks being governed by probability values.
Results:
Because the occurrence of a single complication increases the risk of further complications, subjects who encounter their first complication are more likely to experience a second, third or even more complications, before they leave the 'bad track' and their personal chain of cascading complications becomes discontinued. The model of a Markov chain explains why the overall number of complications in the total population of patients with digestive disease remains low even if individual patients are expected to encounter more than a single complication.
Conclusions:
Published complication rates for gastrointestinal procedures underestimate the true risk to the patient, because they do not consider the added vulnerability to cascading complications after the first event.
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