Bird Geoffrey L, Jeffries Howard E, Licht Daniel J, Wernovsky Gil, Weinberg Paul M, Pizarro Christian, Stellin Giovanni
Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
Cardiol Young. 2008 Dec;18 Suppl 2(Suppl 2):234-9. doi: 10.1017/S1047951108002977.
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval. The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrine systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the neurological system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases. Although neurological injury and adverse neurodevelopmental outcome can follow procedures for congenital cardiac defects, much of the variability in neurological outcome is now recognized to be more related to patient specific factors rather than procedural factors. Additionally, the recognition of pre and postoperative neurological morbidity requires procedures and imaging modalities that can be resource-intensive to acquire and analyze, and little is known or described about variations in "sampling rate" from centre to centre. The purpose of this effort is to propose an initial set of consensus definitions for neurological complications following congenital cardiac surgery and intervention. Given the dramatic advances in understanding achieved to date, and those yet to occur, this effort is explicitly recognized as only the initial first step of a process that must remain iterative. This list is a component of a systems-based compendium of complications that may help standardize terminology and possibly enhance the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease may be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.
并发症是与疾病或医疗干预相关的事件或情况，偏离了预期的事件进程，可能导致或与不理想的结果相关。并发症不一定代表构成医疗过失或医疗事故的医疗护理标准的违反。手术或操作并发症是指任何并发症，无论其原因如何，发生在以下情况：(1) 手术或干预（无论是否在医院内）后30天内，或(2) 手术或干预后同一住院期间的30天后。在此时间间隔内，手术和操作并发症包括术中/操作中并发症和术后/操作后并发症。儿科和先天性心脏病多学会数据库委员会已经列出了与先天性心脏病患者治疗相关的一系列全面并发症，涉及心脏、肺、肾、血液、感染、神经、胃肠和内分泌系统，以及与麻醉和灌注管理以及胸器官移植相关的并发症。本手稿的目的是研究与神经系统具体相关的手术发病率的定义。这些具体定义和术语将用于以通用语言在许多独立数据库中跟踪与手术和经导管干预及其他治疗形式相关的发病率。尽管先天性心脏缺陷手术后可能会出现神经损伤和不良神经发育结果，但现在人们认识到，神经结果的许多变异性更多地与患者特定因素而非手术因素相关。此外，识别术前和术后神经发病率需要的程序和成像方式获取和分析可能需要大量资源，而且关于各中心“采样率”的差异知之甚少或描述不多。这项工作的目的是为先天性心脏手术和干预后的神经并发症提出一套初步的共识定义。鉴于迄今为止在认识方面取得的巨大进展以及未来还会出现的进展，这项工作明确被视为一个必须不断迭代的过程的仅第一步。该列表是基于系统的并发症汇编的一部分，可能有助于规范术语，并可能加强对先天性心脏畸形患者发病率的研究和量化。照顾先天性心脏病患者的临床医生可能能够将此列表用于数据库、质量改进计划、并发症报告以及比较治疗策略。
