Quality of complication reporting in the surgical literature.
OBJECTIVE
To identify 10 critical elements of accurate and comprehensive reports of surgical complications.


BACKGROUND
Despite a venerable tradition of weekly morbidity and mortality conferences, inconsistent complication reporting is common in the surgical literature.


METHODS
An analysis of articles reporting short-term outcomes after pancreatectomy, esophagectomy, and hepatectomy was performed. Randomized clinical trials (RCTs) published from 1975 to 2001 and retrospective series of more than 100 patients published from 1990 to 2001 were reviewed.


RESULTS
A total of 119 articles reporting outcomes in 22,530 patients were analyzed. This included 42 RCTs and 77 retrospective series. Of the 10 criteria developed, no articles met all criteria; 2% met 9 criteria, 38% 7 or 8, 34% 5 or 6, 40% 3 or 4, and 12% 1 or 2. Outpatient information (22% of articles), definitions of complications provided (34% of articles), severity grade used (20% of articles), and risk factors included in analysis (29% of articles) were the most commonly unmet quality reporting criteria. Type of study (RCT vs. retrospective), site of institution (U.S. vs. non-U.S.) and journal (U.S. vs. non-U.S.) did not influence the quality of complication reporting.


CONCLUSIONS
Short-term surgical outcomes are routinely included in the data reported in the surgical literature. This is often used to show improvements over time or to assess the impact of therapeutic changes on patient outcome. The inconsistency of reporting and the lack of accepted principles of accrual, display, and analysis of complication data argue strongly for the creation and generalized use of standards for reporting this information.
Martin
Robert C G
RC
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Brennan
Murray F
MF
Jaques
David P
DP
D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D016629:Esophagectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D006498:Hepatectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D018156:Journalism, Medical / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D010506:Periodicals as Topic / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013223:Statistics as Topic / Q000592:standards