Gomes Nuno V, Polutak Amar, Schindler Christian, Weber Walter P, Steiner Luzius A, Rosenthal Rachel, Dell-Kuster Salome
Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Department of Clinical Research, University of Basel, Basel, Switzerland.
Ann Surg. 2023 Nov 1;278(5):e981-e987. doi: 10.1097/SLA.0000000000005807. Epub 2023 Jan 24.
To assess the discrepancy between perioperative complications, prospectively recorded during a cohort study versus retrospectively from health records.
Perioperative adverse events are relevant for patient outcome, but incomplete reporting is common.
Two physicians independently recorded all intraoperative adverse events according to ClassIntra and all postoperative complications according to the Clavien-Dindo classification based on all available health records. These retrospective assessments were compared with the number and severity of those prospectively assessed in the same patients during their inclusion in 1 center of a prospective multicenter cohort study.
Interrater agreement between both physicians for retrospective recording was high [intraclass correlation coefficient: 0.89 (95% CI, 0.86, 0.91) for intraoperative and 0.88 (95% CI, 0.85, 0.90) for postoperative complications]. In 320 patients, the incidence rate was higher retrospectively than prospectively for any intraoperative complication (incidence rate ratio: 1.79; 95% CI, 1.50, 2.13) and for any postoperative complication (incidence rate ratio: 2.21; 95% CI, 1.90, 2.56). In 71 patients, the severity of the most severe intraoperative complication was higher in the retrospective than in the prospective data collection, whereas in 69 the grading was lower. In 106 patients, the severity of the most severe postoperative complication was higher in the retrospective than in the prospective data collection, whereas in 19 the grading was lower.
There is a noticeable discrepancy in the number and severity of reported perioperative complications between these 2 data collection methods. On the basis of the double-blinded assessment of 2 independent raters, our study renders prospective underreporting more likely than retrospective overreporting.
评估队列研究中前瞻性记录的围手术期并发症与从健康记录中回顾性获取的并发症之间的差异。
围手术期不良事件与患者预后相关，但报告不完整很常见。
两名医生根据所有可用的健康记录，独立记录所有术中不良事件（根据ClassIntra分类）以及所有术后并发症（根据Clavien-Dindo分类）。将这些回顾性评估结果与同一患者在前瞻性多中心队列研究的一个中心纳入研究期间前瞻性评估的数量和严重程度进行比较。
两名医生之间回顾性记录的组内相关系数较高[术中为0.89（95%CI，0.86，0.91），术后并发症为0.88（95%CI, 0.85, 0.90）]。在320例患者中，任何术中并发症的发生率回顾性高于前瞻性（发生率比：1.79；95%CI，1.50，2.13），任何术后并发症的发生率回顾性高于前瞻性（发生率比：2.21；95%CI，1.90，2.56）。在71例患者中，回顾性数据收集中最严重术中并发症的严重程度高于前瞻性数据收集，而在69例患者中分级较低。在106例患者中，回顾性数据收集中最严重术后并发症的严重程度高于前瞻性数据收集，而在19例患者中分级较低。
这两种数据收集方法在报告的围手术期并发症数量和严重程度上存在明显差异。基于两名独立评估者的双盲评估，我们的研究表明前瞻性报告不足比回顾性报告过度更有可能。
