Incidence of postoperative complications is underestimated if outcome data are recorded by interns and first year residents in a low volume hospital setting

Abstract

Quality of outcome measurement in a district hospital is poor if done by unexperienced residents and significantly underestimates the true complication rate. Outcome measurement must be done or supervised by experienced surgeons to ensure correct and reliable outcome data. The aim of this study is to evaluate the accuracy of outcome reporting after elective visceral surgery in a low volume district hospital. Outcome measurement as well as transparent reporting of surgical complications becomes more and more important. In the future, financial and personal resources may be distributed due to reported quality and thus, it is in the main interest of healthcare providers that outcome data are accurately collected. Between 10/ 2020 and 09/ 2021 postoperative complications during the hospitalisation were recorded using the Clavien - Dindo classification (CDC) and comprehensive complication index (CCIâ) by residents of a surgical department in a district hospital. After one year of prospective data collection, data were retrospectively analyzed and re-evaluated for accuracy by senior consultant surgeons. In 575 patients undergoing elective general or visceral surgery interns and residents reported an overall rate of patients with complications of 7.3% (n=42) during the hospitalization phase, whereas a rate of 18.3% (n=105) was revealed after retrospective analysis by senior consultant surgeons. Thus, residents failed to report postoperative complications in 60% of cases (63/105). In the 42 cases, in which complications were initially reported, the grading of complications was correct only in 33.3% of cases (n=14). Complication grades that were most missed were CDC grade I and II.