title: Development and assessment of Memorial Sloan Kettering Cancer Center's Surgical Secondary Events grading system.
abstract: BACKGROUND
  Studying surgical secondary events is an evolving effort with no current established system for database design, standard reporting, or definitions. Using the Clavien-Dindo classification as a guide, in 2001 we developed a Surgical Secondary Events database based on grade of event and required intervention to begin prospectively recording and analyzing all surgical secondary events (SSE).
  
  
  METHODS
  Events are prospectively entered into the database by attending surgeons, house staff, and research staff. In 2008 we performed a blinded external audit of 1,498 operations that were randomly selected to examine the quality and reliability of the data.
  
  
  RESULTS
  Of 4,284 operations, 1,498 were audited during the third quarter of 2008. Of these operations, 79 % (N = 1,180) did not have a secondary event while 21 % (N = 318) had an identified event; 91 % of operations (1,365) were correctly entered into the SSE database. Also 97 % (129 of 133) of missed secondary events were grades I and II. There were 3 grade III (2 %) and 1 grade IV (1 %) secondary event that were missed. There were no missed grade 5 secondary events.
  
  
  CONCLUSIONS
  Grade III-IV events are more accurately collected than grade I-II events. Robust and accurate secondary events data can be collected by clinicians and research staff, and these data can safely be used for quality improvement projects and research.
authors.affiliation: Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA, strongv@mskcc.org.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
authors.forename: Luke V
authors.initials: LV
authors.lastname: Selby
authors.forename: Mindy
authors.initials: M
authors.lastname: Sovel
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: William
authors.initials: W
authors.lastname: Hoskins
authors.forename: Ronald
authors.initials: R
authors.lastname: Dematteo
authors.forename: Peter
authors.initials: P
authors.lastname: Scardino
authors.forename: David P
authors.initials: DP
authors.lastname: Jaques
mesh_terms: D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D009369:Neoplasms / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D058996:Quality Improvement; D055502:Secondary Prevention