title: Which clinical scenarios do surgeons record as complications? A benchmarking study of seven hospitals.
abstract: OBJECTIVE
  To investigate agreement and potential differences in the application and interpretation of the definition among surgical departments of various hospitals.
  
  
  METHODS
  24 cases were formulated including general, trauma, gastrointestinal and vascular surgery, and based on points of discussion about the definition and ambiguities regarding complication registration as encountered in daily practice. The cases were presented to the surgical staff and residents in seven Dutch hospitals, using the national registration system of complications and an electronic response system.
  
  
  RESULTS
  In total, 134 participants responded. Interpretation differences were particularly found regarding: (1) complications considered as logical consequences of a surgical procedure; (2) complications occurring after radiological interventions; (3) severity criteria such as when to consider a complication as a '(probably) permanent damage or function loss'; (4) registering a cancelled operation as a complication and (5) patients with serial complications during hospital stay.
  
  
  CONCLUSIONS
  The definition of surgical complications as currently applied in the Netherlands does not ensure a uniform complication registration. Improvement of this registration system is mandatory before benchmarking of these findings in the public domain is appropriate. Modifications of the current definition of a surgical complication, and improved consensus about specific clinical situations and training of surgeons might improve the quality of benchmarking.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Visser
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D001071:Appointments and Schedules; D019985:Benchmarking; D002983:Clinical Competence / Q000592:standards*; D032921:Consensus; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008505:Medical Staff, Hospital / Q000592:standards*; D009426:Netherlands; D015588:Observer Variation; D011183:Postoperative Complications; D012042:Registries; D066231:Surgeons / Q000592:standards*; D009626:Terminology as Topic