Lindholm S, Lindskogen S, Gamage B, Kurlberg G, Ljungman D
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Surgery, Colombo South Teaching Hospital, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
Ann Med Surg (Lond). 2022 Jun 18;79:104018. doi: 10.1016/j.amsu.2022.104018. eCollection 2022 Jul.
The colorectal cancer (CRC) incidence is increasing in low- and middle-income countries (LMICs) as part of an ongoing epidemiological transition. Surgery is the main treatment and surgical services are scaled up to meet the need. This warrants the establishment of frugal systems to measure safety and quality of surgical care that are tailored for low-resource settings. The aim of this study was to test the applicability of the Clavien-Dindo classification (CDC) for measurement of surgical complications in an LMIC setting where medical records are paper-based.
88 patients who underwent CRC resection at Colombo South Teaching Hospital, Sri Lanka, from January 2017 to January 2020 were included. Medical records were retrospectively reviewed for postoperative complications and the severity was graded using the CDC.
One or more postoperative complications (CDC ≥ grade II) occurred in 45.5% (n = 40) of the patients. The complications were distributed as grade II n = 46, grade III n = 3, grade IV n = 2 and grade V n = 0. The most common complication (22.7%, n = 20) was postoperative anemia treated with blood transfusion. The second most common complication was incisional surgical site infection (11.4%, n = 10).
Postoperative outcome could be evaluated by using the CDC in a Sri Lankan facility based on retrospective review of medical records. This suggests that the CDC is a feasible standardized system appropriate for measuring surgical quality also in other LMICs. Identified fields for possible quality improvement at the study site were to limit blood transfusions and minimize treatment with antibiotics.
作为正在进行的流行病学转变的一部分，低收入和中等收入国家（LMICs）的结直肠癌（CRC）发病率正在上升。手术是主要治疗方法，手术服务正在扩大以满足需求。这就需要建立节俭的系统来衡量针对低资源环境量身定制的手术护理的安全性和质量。本研究的目的是测试Clavien-Dindo分类（CDC）在基于纸质病历的LMIC环境中测量手术并发症的适用性。
纳入2017年1月至2020年1月在斯里兰卡科伦坡南部教学医院接受CRC切除手术的88例患者。对病历进行回顾性审查以了解术后并发症，并使用CDC对严重程度进行分级。
45.5%（n = 40）的患者发生了一种或多种术后并发症（CDC≥II级）。并发症分布为II级n = 46，III级n = 3，IV级n = 2，V级n = 0。最常见的并发症（22.7%，n = 20）是术后贫血，通过输血治疗。第二常见的并发症是手术切口部位感染（11.4%，n = 10）。
通过对病历的回顾性审查，在斯里兰卡的一家医疗机构中可以使用CDC评估术后结果。这表明CDC是一个可行的标准化系统，也适用于测量其他LMICs的手术质量。在研究地点确定的可能改进质量的领域是限制输血和尽量减少抗生素治疗。
