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The extended postoperative complication score: A dual-axis reporting plan for general surgery.
Federico Coccolini1, Enrico Cicuttin, Mircea Chirica
1Department of General, Emergency, and Trauma Surgery, Pisa University Hospital, Pisa, Italy (F.C., C.C.); Department of General, Emergency, and Trauma Surgery, Pavia University Hospital, Pavia, Italy (E.C.); Department of General and Emergency Surgery, Grenoble University Hospital, Grenoble, France (M.C.); Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russia (V.R.); Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA (R.C.); Department of General and Emergency Surgery, Macerata Hospital, Macerata, Italy (M.S.); Department of General and Emergency Surgery, Istanbul Medeniyet University, Istanbul, Turkey (A.I.); Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA (W.L.B.); Department of Cardiac Surgery, Pisa University Hospital, Pisa, Italy (A.C., L.B.); Department of General and Emergency Surgery, Legnano Hospital, Legnano, Italy (D.M.); Division of General Surgery, Rambam Health Care Campus, Haifa, Israel (Y.K.); Department of General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy (M.C.); Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (H.K., M.C.); Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado (E.E.M.); Division of Surgery, Hillel Yaffe Medical Center, Hadera, Israel (B.K.); Department of Cardiothoracic and Vascular Surgery and Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (T.H.); Department of Surgery, Inova Fairfax Hospital, Fairfax County, VA (P.F.); Department of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada (A.W.K.); 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece (M.P.); Department of General, Emergency, and Trauma Surgery, Bufalini Hospital, Cesena, Italy (F.C.); Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, PA (G.B.).
A new Extended Postoperative Complication Score (EPCS) stratifies surgical patients by baseline health and complication severity. This dual-axis system improves outcome reporting and surgical quality evaluation.
Area of Science:
- Surgical outcomes research
- Patient safety and quality improvement
- Trauma and emergency surgery
Background:
- Current surgical complication grading systems lack consistency in accounting for patient vulnerability and conflate treatment with severity.
- This limits interpretability across diverse surgical populations, especially in emergency and general surgery.
Purpose of the Study:
- To develop and present the Extended Postoperative Complication Score (EPCS), a novel dual-axis classification system for grading surgical complications and sequelae.
- To improve the accuracy and interpretability of surgical outcome reporting by considering both patient factors and event severity.
Main Methods:
- A modified Delphi process involving a multidisciplinary expert panel and international surgical associations.
- Development of a dual-axis system stratifying patients into three baseline classes (physiologic reserve) and grading postoperative events by physiologic impact (Grade 0-IV).
- Separate categorization of sequelae and integration into 18 mutually exclusive strata.
Main Results:
- The EPCS combines five complication grades and three baseline classes, with three sequelae codes, creating 18 distinct outcome strata.
- Expert consensus affirmed the system's conceptual clarity and operational feasibility for various surgical settings (elective, urgent, emergent).
- The EPCS is suitable for clinical audit, observational research, and pragmatic trials.
Conclusions:
- The EPCS offers a structured, physiologically anchored approach to stratifying postoperative complications.
- Its dual-axis design enhances the validity of outcome comparisons and supports real-world surgical quality assessment.
- Prospective multicenter validation is recommended to further establish the EPCS's utility.
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