Systematic classification of morbidity and mortality after thoracic surgery

Area of Science:

• Thoracic Surgery
• Surgical Quality Assurance
• Morbidity and Mortality Reporting

Background:

• Objective reporting of postoperative complications is crucial for surgical quality assurance.
• A novel system was developed to identify and grade thoracic surgical complications.
• The system's feasibility and utility were evaluated over two years.

Purpose of the Study:

• To develop and evaluate a standardized system for identifying the presence and severity of thoracic surgical complications.
• To assess the feasibility and utility of this system for quality assurance.

Main Methods:

• The system is based on the Clavien-Dindo classification, correlating complication severity with treatment effort.
• Definitions were established through peer review and questionnaires.
• Prospective evaluation of all patients undergoing thoracic surgery between January 2008 and December 2009.

Main Results:

• Of 1260 procedures in 953 patients, 29.3% had complications.
• Minor complications (Grades I-II) were most frequent (68.8%), while major complications (Grades III-IV) were 28.9%.
• Overall mortality (Grade V) was 2.2%. Prolonged air leak and atrial fibrillation were most common.

Conclusions:

• A standardized classification system for thoracic surgical complications is feasible.
• The system facilitates objective comparison and identifies the burden of individual complications.
• It provides an effective method for continuous surgical quality assessment.