Assessment of Surgical Complications With Respect to the Surgical Indication: Proposal for a Novel Index.

Morand, Grégoire B; Anderegg, Nanina; Kleinjung, Tobias; Bohlender, Jörg E; Veraguth, Dorothe; Broglie, Martina A; Holzmann, David; Huber, Alexander M; Röösli, Christof; Soyka, Michael B (2021). Assessment of Surgical Complications With Respect to the Surgical Indication: Proposal for a Novel Index. Frontiers in Surgery, 8, p. 638057. Frontiers 10.3389/fsurg.2021.638057

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Introduction: The Clavien-Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them. A drawback of the method is that it does not consider why the patient was operated on primarily. Methods: We designed a novel index based on Clavien-Dindo but with respect to the surgical indication. We surveyed an international panel of otolaryngologists who filled out a questionnaire with 32 real case-inspired scenarios. Each case was graded for the surgical complication, surgical indication, and a subjective rating whether the complication was acceptable or not. Results: Seventy-seven otolaryngologists responded to the survey. Mean subjective rating and surgical complication grading for each scenario showed an inverse correlation (r2 = 0.147, p = 0.044). When grading the surgical complication with respect to the surgical indication, the correlation with the subjective rating increased dramatically (r2 = 0.307, p = 0.0022). Conclusion: We describe a novel index grading surgical complications with respect to the surgical indication. In our survey, most respondents judged a complication as acceptable or not according to its grade but kept in mind the surgical indication. This subjective judgment could be quantified with our novel index.

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