title: Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology.
abstract: BACKGROUND
  Most studies use hospital data to calculate postoperative complication rates (PCRs). We report on improving PCR estimates through use of patient-reporting.
  
  
  METHODS
  A prospective cohort study of major surgery performed at 10 UK gynaecological cancer centres was undertaken. Hospitals entered the data contemporaneously into an online database. Patients were sent follow-up letters to capture postoperative complications. Grade II-V (Clavien-Dindo classification) patient-reported postoperative complications were verified from hospital records. Postoperative complication rate was defined as the proportion of surgeries with a Grade II-V postoperative complication.
  
  
  RESULTS
  Patient replies were received for 1462 (68%) of 2152 surgeries undertaken between April 2010 and February 2012. Overall, 452 Grade II-V (402 II, 50 III-V) complications were reported in 379 of the 1462 surgeries. This included 172 surgeries with 200 hospital-reported complications and 231 with 280 patient-reported complications. All (100% concordance) 36 Grade III-V and 158 of 280 (56.4% concordance) Grade II patient-reported complications were verified on hospital case-note review. The PCR using hospital-reported data was 11.8% (172 out of 1462; 95% CI 11-14), patient-reported was 15.8% (231 out of 1462; 95% CI 14-17.8), hospital and verified patient-reported was 19.4% (283 out of 1462; 95% CI 17.4-21.4) and all data were 25.9% (379 out of 1462; 95% CI 24-28). After excluding Grade II complications, the hospital and patient verified Grade III-V PCR was 3.3% (48 out of 1462; 95% CI 2.5-4.3).
  
  
  CONCLUSIONS
  This is the first prospective study of postoperative complications we are aware of in gynaecological oncology to include the patient-reported data. Patient-reporting is invaluable for obtaining complete information on postoperative complications. Primary care case-note review is likely to improve verification rates of patient-reported Grade II complications.
authors.affiliation: University College, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Iyer
authors.forename: A
authors.initials: A
authors.lastname: Gentry-Maharaj
authors.forename: A
authors.initials: A
authors.lastname: Nordin
authors.forename: R
authors.initials: R
authors.lastname: Liston
authors.forename: M
authors.initials: M
authors.lastname: Burnell
authors.forename: N
authors.initials: N
authors.lastname: Das
authors.forename: R
authors.initials: R
authors.lastname: Desai
authors.forename: R
authors.initials: R
authors.lastname: Gornall
authors.forename: A
authors.initials: A
authors.lastname: Beardmore-Gray
authors.forename: K
authors.initials: K
authors.lastname: Hillaby
authors.forename: S
authors.initials: S
authors.lastname: Leeson
authors.forename: A
authors.initials: A
authors.lastname: Linder
authors.forename: A
authors.initials: A
authors.lastname: Lopes
authors.forename: D
authors.initials: D
authors.lastname: Meechan
authors.forename: T
authors.initials: T
authors.lastname: Mould
authors.forename: J
authors.initials: J
authors.lastname: Nevin
authors.forename: A
authors.initials: A
authors.lastname: Olaitan
authors.forename: B
authors.initials: B
authors.lastname: Rufford
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.forename: S
authors.initials: S
authors.lastname: Shanbhag
authors.forename: A
authors.initials: A
authors.lastname: Thackeray
authors.forename: N
authors.initials: N
authors.lastname: Wood
authors.forename: K
authors.initials: K
authors.lastname: Reynolds
authors.forename: U
authors.initials: U
authors.lastname: Menon
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010358:Patient Participation; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D057566:Self Report