title: Prospective validation of a surgical complications grading system in a cohort of 2114 patients.
abstract: BACKGROUND
  We recently reported a grading system for surgical complications. This system proved to have a high sensitivity for recording minor but meaningful complications prolonging hospital stay in patients after colorectal surgery. We aimed to prospectively validate the complication grading system in a general surgery department over 1 year.
  
  
  METHODS
  All surgical procedures and related complications were prospectively recorded between January 1st and December 31st, 2009. Surgical complications were graded on a severity scale of 1-5. The system classifies short-term outcome by grade emphasizing intensity of therapy required for treatment of the defined complication.
  
  
  RESULTS
  During the study period, 2114 patients underwent surgery. Elective and oncological surgeries were performed in 1606 (76%) and 465 (22%) patients, respectively. There were 422 surgical complications in 304 (14%) patients (Grade 1/2: 203 [67%]; Grade 3/4: 90 [29%]; Grade 5: 11 [4%]). Median length of stay correlated significantly with complication severity: 2.3 d for no complication, 6.2 and 11.8 d for Grades 1/2 and 3/4, respectively (P < 0.001). Older age (OR 2.75, P < 0.001), comorbidities (OR 1.44, P = 0.02), American Society of Anesthesiology score >2 (OR 2.07, P < 0.001), contamination Grade (OR 1.85, P = 0.001), oncological (OR 2.82, P < 0.001), open (OR 1.22, P = 0.03), prolonged >120 min (OR 2.08, P < 0.001), and emergency surgery (OR 1.42, P = 0.02) independently predicted postoperative complications.
  
  
  CONCLUSIONS
  This system of grading surgical complications permits standardized reporting of surgical morbidity according to the severity of impact. Prospective validation of this system supports its use in a general surgery setting as a tool for surgical outcome assessment and quality assurance.
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Cohen
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Mizrahi
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Hamburger
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Bassam
authors.initials: B
authors.lastname: Abu-Wasel
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Bilal
authors.initials: B
authors.lastname: Alaiyan
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Herbert R
authors.initials: HR
authors.lastname: Freund
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eid
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel. Electronic address: anissan@hadassah.org.il.
authors.forename: Aviram
authors.initials: A
authors.lastname: Nissan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000145:classification* / Q000453:epidemiology*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adverse events; Complications; Length of stay; Morbidity; Severity score; Surgery