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Assessment of Surgical Complications With Respect to the Surgical Indication: Proposal for a Novel Index
Grégoire B Morand1,2, Nanina Anderegg3, Tobias Kleinjung1,2
1Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
Insights
A new index improves surgical complication assessment by considering the reason for surgery. This approach better reflects surgeons
Area of Science:
- Surgical Outcomes Research
- Medical Classification Systems
- Otolaryngology
Background:
- The Clavien-Dindo classification is widely used for grading surgical complications based on treatment required.
- A limitation of the Clavien-Dindo system is its failure to account for the primary surgical indication.
Purpose of the Study:
- To develop and validate a novel index for grading surgical complications that incorporates the surgical indication.
- To assess how surgical indication influences the perceived acceptability of complications.
Main Methods:
- A new index was designed, modifying the Clavien-Dindo system to include surgical indication.
- An international panel of 77 otolaryngologists evaluated 32 real-world surgical scenarios.
- Participants graded complications, surgical indications, and rated complication acceptability.
Main Results:
- A significant inverse correlation was found between standard complication grading and subjective acceptability ratings.
- Incorporating surgical indication into complication grading substantially increased the correlation with subjective acceptability (r² = 0.307, p = 0.0022).
Conclusions:
- A novel index for grading surgical complications relative to surgical indication has been developed.
- Surgeons' judgment of complication acceptability is influenced by the underlying surgical indication.
- The proposed index quantifies this subjective judgment, offering a more nuanced assessment of surgical outcomes.
Abstract:
Introduction: The Clavien-Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them. A drawback of the method is that it does not consider why the patient was operated on primarily. Methods: We designed a novel index based on Clavien-Dindo but with respect to the surgical indication. We surveyed an international panel of otolaryngologists who filled out a questionnaire with 32 real case-inspired scenarios. Each case was graded for the surgical complication, surgical indication, and a subjective rating whether the complication was acceptable or not. Results: Seventy-seven otolaryngologists responded to the survey. Mean subjective rating and surgical complication grading for each scenario showed an inverse correlation (r 2 = 0.147, p = 0.044). When grading the surgical complication with respect to the surgical indication, the correlation with the subjective rating increased dramatically (r 2 = 0.307, p = 0.0022). Conclusion: We describe a novel index grading surgical complications with respect to the surgical indication. In our survey, most respondents judged a complication as acceptable or not according to its grade but kept in mind the surgical indication. This subjective judgment could be quantified with our novel index.
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