An analysis of surgical complications; a tool to improve surgical outcome

Complications in surgery are an important cause of morbidity and mortality. Complications may result in an increased length of stay in hospital, repeat surgery, additional medical treatment, legal issues and increased costs. Classification and regular audit of complications is a useful tool to improve patient safety and surgical outcome. The purpose of this study is to identify and classify surgical complications and evaluate the various contributing factors. The complications were categorized by Clavein Dindo system as Grade 1:52 (29.1%), Grade II :45 (25.1%),Grade IIIa:26 (14.5%), Grade IIIB:25 (14%), Grade IVa:5 (2.8%), Grade IVb:0 and Grade V:26 (14.5%) . The complication rate was 5.3% and mortality rate was 0.8% in total 3336 surgical procedures. There was significantly higher mortality in complications due to patient related factors 23.4% (11/47), compared to technical factors 4.2% (2/48) and other factors 15.4% (13/84) (p value = 0.024). The mortality was significantly higher in the patients who required ICU care, 54% (20/37), in class B surgical procedures 22.4% (22/98) and those who developed complications after emergency procedures were 31% (14/45). The mortality was significantly higher in the patients who required medical intervention for various medical complications 30.1% (19/63) compared to those who required surgical intervention 8.4% (5/59) or were managed conservatively 3.5% (2/57) (p value = 0.0001).