Classifying surgical complications: a critical appraisal.

HYPOTHESIS

Inconsistency exists in methods of classifying complications after colorectal surgery with anastomosis, which may result in incomplete availability of data.

DESIGN

Retrospective study.

SETTING

Nonuniversity teaching hospital.

PATIENTS

All patients with complications after colorectal surgery with anastomosis performed from January 1, 1995, through December 31, 2001.

INTERVENTIONS

Incidence and type of complications and classification systems used were recorded. Complications were classified according to the systems of the Association of Surgery of The Netherlands and the Trauma Registry of the American College of Surgeons.

MAIN OUTCOME MEASURES

Classification of complications and systems used to record them.

RESULTS

Colorectal surgery was performed in 505 patients. In 181 patients, 437 complications were recorded, and 350 (80%) of these events represented 13 types of complications. Different classification systems were used, and no consistent approach in classifying was seen. Anastomotic disruption (n = 40), the most serious complication after colorectal surgery, was recorded as dehiscence 32 times (80%) in the Association of Surgery of The Netherlands system and as anastomotic leak (code 4001) 24 times (60%) in the Trauma Registry of the American College of Surgeons system.

CONCLUSIONS

Diverse classification systems were used for major complications after colorectal surgery. The differences in classifying seemed to be based on the interpretation of the recording physician. Emphasis should be placed on training physicians on a regular basis in documenting and classifying complications and providing feedback. The reporting process should focus on adequate and uniform classifying of events with major significance, eg, anastomotic disruption in colorectal surgery.