Classification of intraoperative adverse events in visceral surgery

Gawria, Larsa; Rosenthal, Rachel; van Goor, Harry; Dell-Kuster, Salome; ten Broek, R.B.; Rosman, C.; Aduse-Poku, M.; Aghlamandi, S.; Bissett, I.; Blanc, C.; Brandt, C.; Bruppacher, H.R.; Bucher, H.C.; Clancy, C.; Clavien, P.-A.; Delrio, P.; Espin, E.; Engel, A.; Gomes, N.V.; Galanos-Demiris, K.; Gecim, E.; Ghaffari, S.; Gié, O.; Goebel, B.; Hahnloser, D.; Herbst, F.; Ionnadis, O.; Joller, S.; Kang, Soojin; Kirchhoff, P.; Loveday, B.; Martín, R.; Mayr, J.; Meier, S.; Murugesan, J.; Nally, D.; O'Grady, G.; ÖZÇELİK, MENEKŞE; Pace, U.; Passeri, M.; Rabanser, S.; Ranter, B.; Rega, D.; Ridgway, P.F.; Schmid, R.; Schumacher, P.; Solis, A.; Steiner, L.A.; Villarino, L.; Vrochides, D.

doi:10.1016/j.surg.2021.12.011

Classification of intraoperative adverse events in visceral surgery

Atıf İçin Kopyala

Gawria L., Rosenthal R., van Goor H., Dell-Kuster S., ten Broek R., Rosman C., ...Daha Fazla

Surgery (United States), cilt.171, sa.6, ss.1570-1579, 2022 (SCI-Expanded)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 171 Sayı: 6
Basım Tarihi: 2022
Doi Numarası: 10.1016/j.surg.2021.12.011
Dergi Adı: Surgery (United States)
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
Sayfa Sayıları: ss.1570-1579
Ankara Üniversitesi Adresli: Evet

Özet

Background: Intraoperative adverse events (iAEs) are frequent in visceral surgery, but severity and related postoperative outcome are poorly investigated. A novel classification of intraoperative adverse events, ClassIntra, includes surgical and anesthesiologic intraoperative adverse events using 5 severity grades and showed a high criterion and construct validity across all surgical disciplines. ClassIntra was studied for reproducibility in a prespecified group of patients undergoing visceral surgery. Methods: iAEs were recorded in all patients enrolled in the ClassIntra validation study (NCT03009929). Postoperative complications were assessed daily according to the Clavien-Dindo classification. Results of the visceral group were compared with those of the non-visceral group and the full cohort. The risk-adjusted association between most severe intra and postoperative complications was investigated in a multivariable proportional odds model. Second, risk-adjusted association between ClassIntra grade and Comprehensive Complication Index, and postoperative length of stay was investigated. Results: In total, 1,270 out of 2,520 patients (50%) underwent visceral surgery. Compared with the nonvisceral group and full cohort, more intraoperative (337/1270 [27%] vs 273/1250 [22%] vs 610/2520 [24%] patients) and postoperative complications (457/1270 [36%] vs 381/1250 [30%] vs 838/2520 [33%] patients) occurred. The risk for a more severe postoperative complication increased with each ClassIntra grade (odds ratio [95% confidence interval] I vs 0 1.10 [0.73 to 1.66], II vs 0 1.69 [1.10 to 2.60], III vs 0 2.31 [1.21 to 4.41], IV vs 0 2.35 [0.69 to 8.06]). Accordingly, CCI and postoperative length of stay increased with each ClassIntra grade in the visceral group, comparable with the nonvisceral and full cohort. Conclusion: Consistent results for the association of intraoperative adverse events and patient outcomes render ClassIntra a valuable instrument in visceral surgery.