Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia.
Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia.
Eur Urol Oncol. 2023 Aug;6(4):378-389. doi: 10.1016/j.euo.2023.01.002. Epub 2023 Jan 23.
Surgical outcomes and patient morbidity are often surrogate markers of health care quality and efficiency. These parameters can only be used with confidence if the reporting and grading of intra- and postoperative complications are reliable and reproducible. Without uniformity and regulation, the risk of under-reporting, and thus significant underestimation of the burden of intra- and postoperative morbidity, is high and should be of great concern to the international surgical community.
To assess the quality and utility of currently available reporting and classification systems for intra- and postoperative complications, recognise their advantages and pitfalls, discuss the overall implications of these systems for urological surgery, and identify potential solutions for future reporting and classification systems.
A comprehensive search was performed using multiple reputable databases and trial registries up to October 25, 2022. Only studies that adhered to predefined inclusion criteria were included. Study selection and data extraction were independently performed by two review authors. The review was performed according to strict methodological guidelines in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.
A total of 13 papers highlighting 13 various complication systems were critically assessed in this review. All studies proposed an intra- or postoperative complication reporting or grading system that was surgically related. At present, there is no single instrument in clinical practice to account for all relevant complication data. Six of the 13 studies were clinically validated (46%) and only three studies were urology-focused (23%). Meta-analysis was not possible.
Current individual complication tools are flawed, so there is a need for a novel, all-inclusive, specialty-specific reporting and classification system for intra- and postoperative complications. If successfully validated and integrated worldwide, such an instrument would have the potential to play a significant role in reshaping efficiency in health care systems and improving surgical and patient quality of care.
Current tools for reporting and classifying complications during and after surgery underestimate how burdensome such complications can be for patients. We summarise the reporting and classification tools currently available, discuss their advantages and drawbacks, and propose potential solutions for future systems. Our review can help in better understanding the changes required for future tools and how to improve overall surgical outcomes for patients.
手术结果和患者发病率通常是医疗保健质量和效率的替代标志物。只有在报告和分级术中及术后并发症可靠且可重复的情况下，才能有信心地使用这些参数。如果没有统一和规范，就有漏报的风险，因此术中及术后发病率的负担会被严重低估，这应该引起国际外科界的高度关注。
评估目前可用的术中及术后并发症报告和分类系统的质量和实用性，认识其优缺点，讨论这些系统对泌尿外科手术的总体影响，并确定未来报告和分类系统的潜在解决方案。
使用多个知名数据库和试验登记处进行了全面搜索，截至 2022 年 10 月 25 日。仅纳入符合预先确定的纳入标准的研究。两名综述作者独立进行了研究选择和数据提取。该综述根据与 2020 年系统评价和荟萃分析的首选报告项目一致的严格方法学指南进行。
本综述批判性评估了 13 篇强调 13 种不同并发症系统的论文。所有研究都提出了一种与手术相关的术中或术后并发症报告或分级系统。目前，在临床实践中没有单一的工具可以涵盖所有相关的并发症数据。13 项研究中有 6 项（46%）进行了临床验证，只有 3 项（23%）是泌尿外科重点研究。无法进行荟萃分析。
目前的单个并发症工具存在缺陷，因此需要一种新颖的、全面的、专业特有的术中及术后并发症报告和分类系统。如果在全球范围内成功验证和整合，这种工具有可能在重塑医疗保健系统的效率和改善手术和患者护理质量方面发挥重要作用。
目前用于报告和分类手术期间和之后并发症的工具低估了这些并发症对患者的负担有多大。我们总结了目前可用的报告和分类工具，讨论了它们的优缺点，并为未来的系统提出了潜在的解决方案。我们的综述可以帮助更好地理解未来工具所需的改变以及如何改善患者的整体手术结果。
