title: Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery.
abstract: OBJECTIVE
  We aimed to assess postoperative complications prospectively on a daily basis and hypothesized that this would lead to an increase in the number of detected complications.
  
  
  METHODS
  Surgical complications were assessed prospectively during a period of 8months. Systematic documentation was carried out daily during a team meeting (period S). Data were compared to those of a preceding period of 8-months of nonsystematic assessment (period N) in which complications had been documented in a self-reporting fashion. Complications were classified according to the Clavien-Dindo classification.
  
  
  RESULTS
  A total of 1291 patients (mean age: 6.6years) were included. During period S complications were determined in 16% of 790 operations compared to 4% of 741 procedures in period N (p<0.01). This difference was owing to an increased detection of minor complications (grade I-III), i.e. wound infection, dysuria after hypospadias repair or postoperative bleeding. In contrast, the incidence of severe complications (grade IV+V) was not significantly different between the time periods (1.3% in period S and 0.8% in period N). Most frequent major complications were cardiopulmonary arrest, enterocolitis, and death. Severe complications accounted for 8% of complications discussed during weekly morbidity and mortality conferences in period S versus 22% in period N (p<0.05).
  
  
  CONCLUSIONS
  Our results indicate that a systematic documentation of complications on a daily basis reveals a more realistic picture of the incidence of pediatric surgical complications and should be the method of choice.
authors.affiliation: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: Mohammad Valeed Ahmed
authors.initials: MV
authors.lastname: Sethi
authors.affiliation: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Zimmer
authors.affiliation: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: Benno
authors.initials: B
authors.lastname: Ure
authors.affiliation: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Department of Pediatric Surgery, University of Leipzig, Liebigstrasse 20A, 04103 Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Lacher
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004282:Documentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Adverse surgical events; Complications; Pediatric surgery; Systematic assessment