title: Surgical Complications and Their Repercussions.
abstract: OBJECTIVE
  Surgical complications have a significant impact on intended quality of care. The aim of our study was to identify factors that contribute to the propagation of additional postoperative complications.
  
  
  METHODS
  Over a 1-year period, we prospectively identified and retrospectively reviewed data on all patients who experienced a surgical complication within 30 days of their procedure. A complication was defined as any deviation from the expected postoperative course and was described using the Clavien-Dindo classification. Data reviewed included length of stay (LOS), Clavien grade, readmission status, and management of the complication. Surgeries were stratified into retroperitoneal, pelvic, and endoscopic procedures. The association between complications and Clavien grade was measured using Spearman rank-order correlation. The probability of subsequent complications and readmission was measured using exact logistic regression.
  
  
  RESULTS
  Of the 4414 patients who underwent a urologic procedure, 191 (4.3%) had at least one complication. One hundred thirty-four (70%) of these patients had more than one complication, 84 (44%) had more than three complications, and 12 (6.3%) had up to a seventh complication. LOS was affected by the severity of the initial complication. Patients with initial Clavien grades 1, 2, 3a, 3b, and 4 had an LOS of 3.75, 4.17, 4.21, 4.94, and 8.58 days, respectively. Variables associated with the risk of developing a second complication included diabetes mellitus, longer operative times (OR 1.83), and greater estimated blood loss (OR 1.32).
  
  
  CONCLUSIONS
  Surgical patients with an initial complication are at higher risk for multiple subsequent postoperative complications. Complications are associated with an extended LOS and higher readmission rates. Diabetes, longer operative time, and greater blood loss were identified as risk factors for multiple complications.
authors.affiliation: 1 The Arthur Smith Institute for Urology, Northwell Health System , New Hyde Park, New York.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Palmerola
authors.affiliation: 1 The Arthur Smith Institute for Urology, Northwell Health System , New Hyde Park, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hartman
authors.affiliation: 2 Department of Surgery, New York University , New York, New York.
authors.forename: Nithin
authors.initials: N
authors.lastname: Theckumparampil
authors.affiliation: 3 University Hospitals Case Medical Center, Urology Institute, School of Medicine, Case Western Reserve University , Cleveland, Ohio.
authors.forename: Anudeep
authors.initials: A
authors.lastname: Mukkamala
authors.affiliation: 4 Northwell Health System, Biostatistics Unit, The Feinstein Institute for Medical Research , Manhasset, New York.
authors.forename: Joanna
authors.initials: J
authors.lastname: Fishbein
authors.affiliation: 1 The Arthur Smith Institute for Urology, Northwell Health System , New Hyde Park, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwartz
authors.affiliation: 1 The Arthur Smith Institute for Urology, Northwell Health System , New Hyde Park, New York.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data