Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160 Ilsimri, Hwasun-eup, Hwasun-gun, Jeonnam, 519-809, Korea.
World J Surg. 2012 Oct;36(10):2400-11. doi: 10.1007/s00268-012-1693-y.
Postoperative complications still comprise the marker used most frequently to assess the quality of gastrectomy. However, the definition and grading of morbidity is not standardized, hampering meaningful comparisons over time and among centers. This study proposes specific definitions and a reproducible classification of complications following gastrectomy using standardized grading tools.
We defined each complication based on the literature, and adopted the Accordion Severity Grading System to stratify morbidity. The classification was applied to 890 patients with gastric cancer seen between January 2010 and April 2011. The correlation between the complication grades and the length of hospital stay (LOS) was analyzed, and risk factors for complications were examined with special reference to severity grade.
The overall morbidity rate was 18.1 %. Mild complications occurred in 31 patients (3.5 %), moderate in 77 patients (8.7 %), severe--invasive procedure/no general anesthesia (GA) in 27 patients (3.0 %), severe--invasive procedures/GA in 18 patients (2.0 %), and severe--organ failure in 3 patients (0.3 %). Five patients (0.6 %) died postoperatively. The grade of complications had a significant effect on the LOS (p < 0.001). Operating time and cardiovascular and pulmonary co-morbidities were independent risk factors for severe complications [odds ratio (OR) 1.001, p = 0.016; OR 2.226, p = 0.006; OR = 2.896, p = 0.003, respectively].
The complications after gastrectomy could be classified into different severity grades that had distinct clinical outcomes. The use of this classification provides more reliable, practical outcome data. Consequently, complications should be reported using a standardized classification tool such as the Accordion Severity Grading System, which requires consensus on the definition of specific complications.
术后并发症仍然是评估胃切除术质量最常用的指标。然而，发病率的定义和分级尚未标准化，这妨碍了不同时间和不同中心之间的有意义的比较。本研究使用标准化的分级工具，提出了胃切除术后并发症的具体定义和可重复的分类。
我们根据文献定义了每种并发症，并采用了 Accordion 严重程度分级系统对发病率进行分层。该分类应用于 2010 年 1 月至 2011 年 4 月期间就诊的 890 例胃癌患者。分析并发症严重程度与住院时间（LOS）之间的相关性，并特别参考严重程度，检查并发症的危险因素。
总体发病率为 18.1%。轻度并发症 31 例（3.5%），中度并发症 77 例（8.7%），重度并发症（需侵入性操作/无需全身麻醉）27 例（3.0%），重度并发症（需侵入性操作/全身麻醉）18 例（2.0%），重度并发症（器官衰竭）3 例（0.3%）。5 例（0.6%）患者术后死亡。并发症严重程度对 LOS 有显著影响（p<0.001）。手术时间和心血管及肺部合并症是重度并发症的独立危险因素[比值比（OR）1.001，p=0.016；OR 2.226，p=0.006；OR=2.896，p=0.003]。
胃切除术后并发症可分为不同严重程度，其临床结局明显不同。使用这种分类提供了更可靠、更实用的结果数据。因此，应使用标准化的分类工具（如 Accordion 严重程度分级系统）报告并发症，这需要对特定并发症的定义达成共识。
