From the Division of Paediatric General and Thoracic Surgery, McGill University, Montréal, Que. (Balvardi, St-Louis, Yousef, Toobaie, Poenaru); the McConnell Resource Centre, McGill University Health Centre, Montréal, Que. (Guadagno); and the Division of Pediatric General Surgery, University of British Columbia, Vancouver, BC (Baird).
Can J Surg. 2021 Mar 26;64(2):E196-E204. doi: 10.1503/cjs.016919.
Grading scales for adverse surgical outcomes have been poorly characterized to date. The primary aim of this study was to conduct a systematic review to enumerate the various frameworks for grading adverse postoperative outcomes; our secondary objective was to outline the properties of each grading system, identifying its strengths and weaknesses.
We searched 9 databases (Africa Wide Information, Biosis, Cochrane, Embase, Global Health, LILACs, Medline, PubMed and Web of Science) from 1992 (the year the Clavien-Dindo classification system was developed) until Mar. 2, 2017, for studies that aimed to develop or improve on an already existing generalizable system for grading adverse postoperative outcomes. Study selection was duplicated as per PRISMA recommendations. Procedure-specific grading systems were excluded. We assessed the framework, strengths and weaknesses of the systems qualitatively.
We identified 9 studies on 8 adverse outcome grading systems with frameworks generalizable to any surgical procedure. Most systems have not been widely incorporated in the literature. Seven of the 8 systems were produced without including patients' perspectives. Four allowed the derivation of a composite morbidity score, which had limited tangible significance for patients.
Although each instrument identified offered its own advantages, none satisfied the need for a patient-centred tool capable of generating a composite score of all possible postoperative adverse outcomes (complications, sequelae and failure) that enables comparison of noninterventional and surgical management of disease. There is a need for development of a more comprehensive, patient-centred grading system for adverse postoperative outcomes.
迄今为止，针对不良手术结局的分级量表描述得并不完善。本研究的主要目的是进行系统综述，列举各种用于分级不良术后结局的框架；次要目的是概述每个分级系统的特性，明确其优缺点。
我们从 1992 年（Clavien-Dindo 分级系统开发的年份）到 2017 年 3 月 2 日，通过 9 个数据库（Africa Wide Information、Biosis、Cochrane、Embase、Global Health、LILACs、Medline、PubMed 和 Web of Science）进行检索，以查找旨在开发或改进已有可广泛应用于分级不良术后结局的通用系统的研究。按照 PRISMA 建议对研究选择进行重复。排除了针对特定手术的分级系统。我们定性评估了系统的框架、优点和缺点。
我们确定了 9 项研究，涉及 8 种不良结局分级系统，其框架适用于任何外科手术。大多数系统尚未广泛应用于文献中。8 个系统中有 7 个是在没有纳入患者观点的情况下制定的。其中 4 个系统允许得出综合发病率评分，但对患者来说具有有限的实际意义。
尽管每个确定的工具都有其自身的优势，但都无法满足需要一种以患者为中心的工具，能够生成所有可能的术后不良结局（并发症、后遗症和失败）的综合评分，从而能够比较非介入性和手术性疾病管理。需要开发一种更全面、以患者为中心的不良术后结局分级系统。
