Classification of intraoperative adverse events in visceral surgery

Gawria, Larsa; Rosenthal, Rachel; Goor, Harry van; Dell-Kuster, Salome

doi:10.1016/j.surg.2021.12.011

Cited by 15 publications

(11 citation statements)

References 36 publications

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“…Bleeding, hypotension, and organ injury were the most frequently reported subcategories of origin. The addition of origin did not alter the previously reported association between severity of iAEs and postoperative complications [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 80%

“…Our group recently developed and validated ClassIntra ® , an easy-to-use grading system for all types of iAEs, and found a strong association between the severity of intraoperative and postoperative complications in a range of surgical disciplines [ 17 ]. This association was further established for visceral surgery [ 18 ]. Similar to other grading systems, ClassIntra ® does not describe the origin of the iAE.…”

Section: Introductionmentioning

confidence: 99%

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Appraisal of Intraoperative Adverse Events to Improve Postoperative Care

Gawria

Jaber

Broek

et al. 2023

JCM

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Background: Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications. Methods: All patients enrolled in the multicenter ClassIntra® validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other’s ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI®), a weighted sum of all postoperative complications according to the Clavien–Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra® on CCI® was assessed with a multivariable mixed-effects generalized linear regression analysis. Results: Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding (n = 217, 28%), hypotension (n = 118, 15%), and organ injury (n = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI® was observed. Conclusion: Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Appraisal of Intraoperative Adverse Events to Improve Postoperative Care

Gawria

Jaber

Broek

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Evidence supports an association between higher ClassIntra® grade and postoperative complications, and has been externally validated. 27 In the initial ClassIntra publication, more than 100 physicians were surveyed and graded 10 clinical scenarios using ClassIntra, showing an intra-class correlation lower than CLASSIC (0.76 vs. 0.87, respectively). These respondents agreed on the grade of iAE with the principal investigators at a rate of ~60%.…”

Section: Discussionmentioning

confidence: 99%

Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis

et al. 2023

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Introduction:The accurate assessment and grading of adverse events (AE) is essential to ensure comparisons between surgical procedures and outcomes. The current lack of a standardized severity grading system may limit our understanding of the true morbidity attributed to AEs in surgery. The aim of this study is to review the prevalence in which intraoperative adverse event (iAE) severity grading systems are used in the literature, evaluate the strengths and limitations of these systems, and appraise their applicability in clinical studies. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. PubMed, Web of Science, and Scopus were queried to yield all clinical studies reporting the proposal and/or the validation of iAE severity grading systems. Google Scholar, Web of Science, and Scopus were searched separately to identify the articles citing the systems to grade iAEs identified in the first search. Results: Our search yielded 2957 studies, with 7 studies considered for the qualitative synthesis. Five studies considered only surgical-/interventional iAEs, while 2 considered both surgical/interventional and anesthesiologic iAEs. Two included studies validated the iAE severity grading system prospectively. A total of 357 citations were retrieved, with an overall self/nonself-citation ratio of 0.17 (53/304). The majority of citing articles were clinical studies (44.1%). The average number of citations per year was 6.7 citations for each classification/severity system, with only 2.05 citations/year for clinical studies. Of the 158 clinical studies citing the severity grading systems, only 90 (56.9%) used them to grade the iAEs. The appraisal of applicability (mean%/median%) was below the 70% threshold in 3 domains: stakeholder involvement (46/47), clarity of presentation (65/67), and applicability (57/56). Conclusion: Seven severity grading systems for iAEs have been published in the last decade. Despite the importance of collecting and grading the iAEs, these systems are poorly adopted, with only a few studies per year using them. A uniform globally implemented severity grading system is needed to produce comparable data across studies and develop strategies to decrease iAEs, further improving patient safety.

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“…Consequently, we did not score intraoperative complications that occurred in our cohort according to Clavien–Dindo. We opted against the use of the recently described ClassIntra [ 26 ] classification because its validation just took place for visceral surgery [ 27 ]. Paediatric and thoracic surgery patients were underrepresented in the validation cohort with just 3% of the prospectively included 2520 patients [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Complications following metal bar removal after Nuss repair are rare in a duocentric retrospective evaluation

et al. 2022

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Purpose Minimally invasive pectus excavatum repair has gained widespread acceptance and its results and complications are well-described. However, there is a substantial debate on the risks and frequencies of complications following metal bar removal. We, therefore, aimed to analyse all complications that occurred during and after metal bar removal at our two paediatric surgical centres. Methods Bar removal surgeries were identified via procedural codes and electronic records were reviewed using a pre-specified data extraction chart. Both intra- and postoperative complications were included and the latter scored according to Clavien–Dindo. We analysed the influence of the pre-specified potential predictors age, sex, and the number of implanted metal bars on the occurrence of complications using logistic regression. Results We included 279 patients with a median age of 19 years (interquartile range 17–20 years). 15 patients experienced 17 complications. Of 11 postoperative complications, only an enlarging pleural effusion required a chest drain in local anaesthesia, resulting in a Claven-Dindo grade IIIa, whereas the remainder were classified as grade I. Neither age (adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.84–1.13, P = 0.73), nor sex (aOR 0.88, 95% CI 0.19–4.07, P = 0.87) or the number of bars (aOR 0.64, 95% CI 0.15–2.71, P = 0.547) did influence the occurrence of complications. Conclusion Complications following metal bar removal were scarce in our duocentric retrospective series and usually of minor relevance. However, to address the perceived paucity of data on the frequency and severity of complications following metal bar removal, further studies, including large database research is necessary.

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Classification of intraoperative adverse events in visceral surgery

Cited by 15 publications

References 36 publications

Appraisal of Intraoperative Adverse Events to Improve Postoperative Care

Appraisal of Intraoperative Adverse Events to Improve Postoperative Care

Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis

Complications following metal bar removal after Nuss repair are rare in a duocentric retrospective evaluation

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