title: Incidence and significance of postoperative complications occurring between discharge and 30 days: a prospective cohort study.
abstract: Accurate documentation of complications is fundamental to clinical audit and research. While it is established that accurate diagnosis of surgical site infection (SSI) requires follow-up for 30 days; for other complications, there are minimal data quantifying their importance between discharge and 30 days.
  
  
  
  In this prospective cohort study, inpatients undergoing general or vascular surgery were reviewed daily for complications by the medical team and a research fellow. A standardized telephone questionnaire was performed 30 days following surgery. All complications were documented and classified according to severity.
  
  
  
  A total of 237 of 388 patients who completed the telephone survey developed a complication, including 77 who developed a complication for the first time after discharge from hospital. Overall 135 (33%) of a total of 405 complications were identified after discharge. These complications included 36 of 63 (57%) SSI, 6 of 12 small bowel obstructions, and three of four major thromboembolic events and a number of space SSI, urinary infections, functional gastrointestinal problems, and pain management problems. Cardiac, respiratory, and neurologic complications were mainly diagnosed in hospital. Of the 135 "postdischarge" complications, 89 were managed in the community and 46 (34%) resulted in admission to hospital, including seven which required a major intervention. There was one death.
  
  
  
  One-third of complications occurred after discharge, and one-third of these resulted in readmission to hospital. Research and audit based on inpatient data alone significantly underestimates morbidity rates. Discharge planning should include contingency plans for managing problems commonly diagnosed after discharge form hospital.
authors.affiliation: Department of Surgical Sciences, University of Otago, Dunedin, New Zealand; The John Goligher Colorectal Surgical Unit, St James University Hospital, Leeds, United Kingdom. Electronic address: john.woodfield@otago.ac.nz.
authors.forename: John C
authors.initials: JC
authors.lastname: Woodfield
authors.affiliation: Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.
authors.forename: Wiqqas
authors.initials: W
authors.lastname: Jamil
authors.affiliation: Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Sagar
mesh_terms: D000328:Adult; D000368:Aged; D054869:Clinical Audit; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology
keywords: Clinical audit; Complications; Follow-up studies; Perioperative care; Surveys and questionnaires; Telephone