Predictors of surgical complications: A systematic review

Operative complications occur more frequently, often are more preventable, and their consequences can be more severe than other types of complications. Controversy exists regarding how best to identify and predict operative complications. Several studies on predictive factors for operative complications focused on a specific predictor for a specific outcome. To develop a reliable tool to identify patients with operative complications, insight in predictive factors for operative complications is required.

We searched all publications addressing predictive factors for the development of operative complications in adult patients admitted to the gastrointestinal, vascular, or general surgery departments. Data were extracted regarding study design, patient characteristics, operative specialty, types of operative procedures, types of complications, possible predictors, and associated complication risk increase (expressed as an odds ratio; OR).

The final set of 30 articles yielded a total of 53 predictive factors studied in various settings, operative specialties, and disorders. To focus our analysis we selected the 25 most robust and clinically applicable factors (ie, appearing in 3 or more studies). These factors were then categorized into 4 different groups: Patient-related factors, Co-morbidities, Laboratory values, and Surgery-related factors. The most predictive factors for morbidity in these groups were body mass index (ORs from 1.80 to 6.30), age (1.02-4.62 years), American Society of Anesthesiologists classification (1.77-7.10), dyspnea (1.23-1.30), serum creatinine (1.39-2.14), emergency surgery (1.50-2.54), and functional status (1.36-4.07).

This review presents a set of factors predictive of operative complications for general surgery departments. These easily retrievable factors can and should be validated in the specific patient populations of each hospital.