title: Grading of complications and risk factor evaluation in laparoscopic colorectal surgery.
abstract: BACKGROUND
  A grading system for postoperative complications is important for quality control and comparison among investigations. The objective of the current study was to evaluate complications associated with laparoscopic colorectal surgery according to a standardized grading system, and to examine risk factors associated with different complication grades.
  
  
  METHODS
  Data of all patients who underwent elective laparoscopic colorectal surgery at two medical centers between September 2003 and January 2011 were collected prospectively. Complications were graded retrospectively into five categories based on a previously proposed grading system for colorectal operations. Age, gender, BMI, Charlson comorbidity score, indication for surgery, pathology site, conversion rate, learning curve, operative times, previous abdominal surgery, concurrent surgical procedures performed, and length of hospital stay were evaluated as risk factors and outcome measures for complications.
  
  
  RESULTS
  A total of 501 patients were included in the study. Of them, 30.5 % suffered at least one complication and 6.5 % more than one. Complications that were mainly medical or surgical site infections requiring minor intervention (grades 1 and 2) occurred in 22.9 % of patients. Surgical complications requiring invasive interference (grades 3 and 4) occurred in 7.4 % of patients and mortality (grade 5) occurred in 0.2 % (1 patient). Length of hospital stay was directly related to complication grade. Average hospital stay was 6.8 ± 3.5, 10.5 ± 5.1, and 20.2 ± 12.3 days for patients with no complications, grade 1-2 complications, and grade 3-4 complications, respectively (p < 0.01). Minor complications (grades 1-2) were associated with conversion (p < 0.01), high Charlson score (p = 0.004), and additional surgical procedures (p = 0.04). Major complications (grades 3-4) were associated solely with conversion (p < 0.01) and rectal pathology (p < 0.01).
  
  
  CONCLUSIONS
  This study demonstrates the use of a uniform grading system for complications in laparoscopic colorectal surgery. Conversion was found to be associated with all grades of complications.
authors: Department of Surgery, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors: Ziv
authors: Z
authors: Asa
authors: Ron
authors: R
authors: Greenberg
authors: Ronen
authors: R
authors: Ghinea
authors: Roy
authors: R
authors: Inbar
authors: Nir
authors: N
authors: Wasserberg
authors: Shmuel
authors: S
authors: Avital
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery; D015897:Comorbidity; D003424:Crohn Disease / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004239:Diverticulitis, Colonic / Q000601:surgery; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery; D007431:Intraoperative Complications / Q000145:classification* / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D016016:Proportional Hazards Models; D012002:Rectal Diseases / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
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