Quality of care and analysis of surgical complications

During the past years evaluation of quality of care has become an important aspect of transparency of care, and complications is one of these parameters. Therefore, we analyzed the complication rate in an academic hospital over a 6-year period.

During the period 2004-2009, all adult surgical patients admitted to and discharged from the Department of Surgery were selected for this time trend study. The Dutch national surgical complication registry was used in the analysis, which registers according to a three-tiered matrix-like classification system. Yearly changes in complication rates were analyzed statistically using the χ(2) for trend test. Subsequently, multivariable regression analysis was used to find significant independent predictors for sustaining a complication.

The mean complication rate per admission rose significantly from 0.18 in 2004 to 0.30 in 2009 (p < 0.001). The largest increase was observed by the following variables: less severe complications, complex surgical procedures, and ASA classification. Delirium, gastoparesis, and ileus were complications showing the largest increase. Age, male gender, ASA, and surgical complexity were found as independent predictors.

This study showed a significant increase of complications. The increase was mainly due to less severe complications, in particular delirium, ileus, and gastroparesis.