Quality assessment in surgery: riding a lame horse.
ABSTRACT Quality assessment in surgery is paramount for patients and health care providers. In our center, quality assessment is based on the recording of preoperative risk factors of each patient and a well-established grading system to track complications. Our prospective quality database is administrated by residents. However, the validity of such data collection is unknown.
To evaluate the validity of the recorded data, a specially trained study nurse audited our prospective quality database over a 6-month period. In the first 3 months, the audit was done in an undisclosed manner. Then, the audit was disclosed to the residents who were again subjected to a teaching course. Thereafter, the audit was continued in a disclosed manner for another 3 months, and data were compared between the 2 periods. Furthermore, we inquired about the strategies to assess surgical quality in 108 European medical centers.
Surprisingly, residents failed to report most complications; 80% (164/206) and 79% (275/347; P = 0.27) of the negative postoperative events were not recorded during the first and the second period, respectively. When captured, however, grading of complications was correct in 97% of the cases. Moreover, comorbidities were incorrectly assessed in 20% of the patients in the first period and in 14% thereafter (P = 0.07). The survey disclosed that residents and junior staff are responsible of recording surgical outcome in 80% of the participating European centers.
Recording of outcome by surgical residents is unreliable,despite active and focused training. Hence, surgery should be evaluated by dedicated personnel.
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ABSTRACT: Introduction: The registration of complications represents an important component in the evaluation of surgical therapeutic procedures. The aim of the present study was to examine the frequency of occurrence as well as the severity of surgical complications after laparoscopic-gynaecological operations in a standardised manner using the Clavien-Dindo system. Material and Methods: Altogether 7438 treatment courses after laparoscopic-gynaecological interventions by 9 working groups were evaluated. Covariates recorded were the technical complexity of the operation, type of study cohort, study size, data acquisition as well as study centre. Target variables recorded were the surgical morbidity rate, subdivided into mild (Clavien-Dindo grade I-II) and severe complications (Clavien-Dindo grade III-V). In addition, a binary logistic regression analysis for the mentioned covariates and the occurrence of surgical complication was carried out. Results: 946 complications were recorded (overall complication rate: 13 %). These included 664 mild complications (8.9 %) and 305 severe complications (4.1 %). A correlation was found between the covariates technical complexity (relative risk [rR] 1.37; p < 0.01), study size (rR: 0.35; p < 0.01) and study centre (rR 0.19; p < 0.01) and the occurrence of surgical complications. Conclusion: By means of a standardised registration of complications using the Clavien-Dindo classification it appears to be possible to limit the methodologically caused underestimation of surgical morbidity in the retrospective evaluation of gynaecological-endoscopic therapeutic procedures. Factors decisively influencing the surgical morbidity of gynaecological-laparoscopic therapeutic procedures are the respective operative experience of the treating facility as well as the technical complexity of the intervention.Geburtshilfe und Frauenheilkunde 08/2014; 74(8):752-758. · 0.85 Impact Factor
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ABSTRACT: Purpose Incisional hernia (IH) is one of the most frequent postoperative complications. Of all patients undergoing IH repair, a vast amount have a hernia which can be defined as a large incisional hernia (LIH). The aim of this study is to identify the preferred technique for LIH repair. Methods A systematic review of the literature was performed and studies describing patients with IH with a diameter of 10 cm or a surface of 100 cm2 or more were included. Recurrence hazards per year were calculated for all techniques using a generalized linear model. Results Fifty-five articles were included, containing 3,945 LIH repairs. Mesh reinforced techniques displayed better recurrence rates and hazards than techniques without mesh reinforcement. Of all the mesh techniques, sublay repair, sandwich technique with sublay mesh and aponeuroplasty with intraperitoneal mesh displayed the best results (recurrence rates of Conclusions The use of mesh during LIH repair displayed the best recurrence rates and hazards. If possible mesh in sublay position should be used in cases of LIH repair.Hernia 11/2014; 19(1). · 2.09 Impact Factor
- Gynecological Surgery 01/2014;