Visser Annelies, Ubbink Dirk T, Gouma Dirk J, Goslings J Carel
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
BMJ Open. 2015 Jun 1;5(6):e007500. doi: 10.1136/bmjopen-2014-007500.
To investigate agreement and potential differences in the application and interpretation of the definition among surgical departments of various hospitals.
24 cases were formulated including general, trauma, gastrointestinal and vascular surgery, and based on points of discussion about the definition and ambiguities regarding complication registration as encountered in daily practice. The cases were presented to the surgical staff and residents in seven Dutch hospitals, using the national registration system of complications and an electronic response system.
In total, 134 participants responded. Interpretation differences were particularly found regarding: (1) complications considered as logical consequences of a surgical procedure; (2) complications occurring after radiological interventions; (3) severity criteria such as when to consider a complication as a '(probably) permanent damage or function loss'; (4) registering a cancelled operation as a complication and (5) patients with serial complications during hospital stay.
The definition of surgical complications as currently applied in the Netherlands does not ensure a uniform complication registration. Improvement of this registration system is mandatory before benchmarking of these findings in the public domain is appropriate. Modifications of the current definition of a surgical complication, and improved consensus about specific clinical situations and training of surgeons might improve the quality of benchmarking.
调查不同医院外科科室在手术并发症定义的应用和解释上的一致性及潜在差异。
设计了24个病例，涵盖普通外科、创伤外科、胃肠外科和血管外科，并基于日常实践中遇到的关于并发症定义及并发症登记的模糊点。这些病例通过国家并发症登记系统和电子应答系统呈现给荷兰七家医院的外科工作人员和住院医师。
共有134名参与者做出回应。特别发现了在以下方面存在解释差异：（1）被视为手术操作必然结果的并发症；（2）放射介入后出现的并发症；（3）严重程度标准，如何时将并发症视为“（可能）永久性损伤或功能丧失”；（4）将取消的手术登记为并发症；（5）住院期间出现系列并发症的患者。
荷兰目前应用的手术并发症定义并不能确保并发症登记的统一。在公共领域对这些结果进行基准比较之前，必须改进这一登记系统。修改当前手术并发症的定义，以及就特定临床情况达成更好的共识并对外科医生进行培训，可能会提高基准比较的质量。
