Gawria Larsa, Jaber Ahmed, Ten Broek Richard Peter Gerardus, Bernasconi Gianmaria, Rosenthal Rachel, Van Goor Harry, Dell-Kuster Salome
Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands.
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, 4051 Basel, Switzerland.
J Clin Med. 2023 Mar 28;12(7):2546. doi: 10.3390/jcm12072546.
Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications.
All patients enrolled in the multicenter ClassIntra validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other's ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI), a weighted sum of all postoperative complications according to the Clavien-Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra on CCI was assessed with a multivariable mixed-effects generalized linear regression analysis.
Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding ( = 217, 28%), hypotension ( = 118, 15%), and organ injury ( = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI was observed.
Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade.
术中不良事件（iAEs）与术后不良结局相关，并造成重大的医疗负担。然而，目前缺乏对术中不良事件的批判性评估。了解术中不良事件的细节可能有助于术后护理。我们对一系列大型手术中的术中不良事件及其与术后并发症的关系进行了全面分析。
本分析纳入了多中心ClassIntra验证研究（NCT03009929）中的所有患者。手术和麻醉团队前瞻性地记录了所有术中不良事件。两名研究人员在彼此不知情的情况下，根据术中不良事件的来源将其分为四类：手术、麻醉、组织或其他，包括器官损伤、心律失常或器械故障等子类别。他们进一步对所有术中不良事件的子类别进行了描述性分析。使用综合并发症指数（CCI）评估术后并发症，CCI是根据Clavien-Dindo分类法对所有术后并发症的加权总和。通过多变量混合效应广义线性回归分析评估术中不良事件来源以及ClassIntra严重程度分级与CCI之间的关联。
在纳入的2520例患者中，610例患者记录了778起术中不良事件。其中，手术相关的有420起（54%），麻醉相关的有283起（36%），组织相关的有34起（4%），其他相关的有41起（5%）。出血（n = 217，28%）、低血压（n = 118，15%）和器官损伤（n = 98，13%）分别是手术和麻醉中最常见的三个子类别。在多变量混合效应分析中，未观察到来源与CCI之间存在显著关联。
分析术中不良事件的类型和来源可提供个性化和情境化信息。即使除严重程度分级外增加来源信息对术后事件的总体预测价值并未提高，但这些详细的描述性信息仍可用于术中及术后护理的针对性监测。
