Department of Surgery, Amphia Hospital, Breda, The Netherlands.
J Surg Res. 2012 Mar;173(1):54-9. doi: 10.1016/j.jss.2010.08.042. Epub 2010 Sep 24.
The objectives of this study were to evaluate the accuracy of a prospective complication registry for documenting complications and identify possible factors for non-registering.
Five hundred randomly selected patients admitted at the Department of Surgery of St. Elisabeth Hospital Tilburg, The Netherlands, in the year 2005, were evaluated for incidence and type of complications by an examination of their medical records and compared with a prospective complication registry. The system was independently reviewed by two persons for missing complications. Patient files with missing complications in the registry were screened for factors possibly responsible for non-registering.
Two hundred thirteen complications were detected, 58 (27%) missing in the registry. There were 50 different types of complications documented. The number of events missing per category were: drug-related (50%, n = 4), organ dysfunction (44%, n = 14), infection-related (25%, n = 19), surgery/intervention-related (23%, n = 14), and hospital-provider errors (19%, n = 7). Not all clinically important complications were adequately documented (e.g., anastomotic leakage). The kappa score was 0.695, making the interrater reliability substantial.
The accuracy of registering complications is fairly acceptable compared to the ranges mentioned in literature. It is disappointing that clinically important events are missing in the registry. The inaccuracy could be explained by a great diversity of documented events, due to a broad definition, suggesting ignorance of the responsible team of which events to register.
本研究旨在评估前瞻性并发症登记系统记录并发症的准确性，并确定未登记的可能因素。
2005 年，在荷兰蒂尔堡圣伊丽莎白医院外科随机选择 500 名患者，通过检查病历评估其并发症的发生率和类型，并与前瞻性并发症登记系统进行比较。该系统由两名独立人员对缺失的并发症进行审查。对登记系统中缺失并发症的患者病历进行筛选，以确定可能导致未登记的因素。
共发现 213 例并发症，其中 58 例（27%）在登记系统中未记录。共记录了 50 种不同类型的并发症。每种类别缺失的事件数分别为：与药物相关（50%，n=4）、器官功能障碍（44%，n=14）、感染相关（25%，n=19）、手术/干预相关（23%，n=14）和医院提供者失误（19%，n=7）。并非所有临床重要的并发症都得到了充分记录（例如吻合口漏）。kappa 评分 0.695，表明评分者间可靠性较高。
与文献中提到的范围相比，登记并发症的准确性相当可接受。令人失望的是，登记系统中缺失了重要的临床事件。由于记录的事件种类繁多，定义广泛，导致准确性不高，这可能是由于负责团队对要登记的事件认识不足。
