Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Prospective observational cohort study on grading the severity of postoperative complications in global surgery research
British Journal of Surgery, Volume 106, No. 2, Year 2019
Notification
URL copied to clipboard!
Description
Background: The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high-(HICs) and low-and middle-income countries (LMICs). Methods: This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results: A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16.8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47.2 per cent) were graded as mild, 4244 (36.4 per cent) as moderate and 1916 (16.4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58.1 per cent) were graded as I or II, 1740 (14.9 per cent) as III, 2408 (20.6 per cent) as IV and 735 (6.3 per cent) as V. Agreement between classification systems was poor overall (ICC 0.41, 95 per cent c.i. 0.20 to 0.55), and in LMICs (ICC 0.23, 0.05 to 0.38) and HICs (ICC 0.46, 0.25 to 0.59). Conclusion: Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally. © 2019 BJS Society Ltd.
Authors & Co-Authors
Abbott, Tom Ef
United Kingdom, London
Queen Mary University of London
United Kingdom, London
London Chest Hospital
Ahmed, Tahania
United Kingdom, London
Queen Mary University of London
Pearse, Rupert M.
United Kingdom, London
Queen Mary University of London
Greaves, Kathryn E.
United Kingdom, London
Barts Health Nhs Trust
Haddow, James Boyd
Unknown Affiliation
Futier, Emmanuel
France, Clermont-ferrand
Centre Hospitalier Universitaire de Clermont-ferrand
Biais, Matthieu
France, Talence
Centre Hospitalier Universitaire de Bordeaux
Slim, Karem
France, Clermont-ferrand
Centre Hospitalier Universitaire de Clermont-ferrand
Beattie, William Scott
Canada, Toronto
Toronto General Hospital
Clavien, Pierre Alain
Switzerland, Zurich
Universitatsspital Zurich
Demartines, Nicolas
Switzerland, Lausanne
Centre Hospitalier Universitaire Vaudois
Fleisher, Lee A.
United States, Philadelphia
University of Pennsylvania
Grocott, Michael P.W.
United Kingdom, Southampton
University Hospital Southampton Nhs Foundation Trust
Hoeft, Andreas
Germany, Bonn
Universitätsklinikum Bonn
Holt, Peter J.E.
Unknown Affiliation
Moreno, Rui Paulo
Unknown Affiliation
Pritchard, Naomi
United Kingdom, Cambridge
University of Cambridge
Rhodes, Andrew
United Kingdom, London
St George’s, University of London
Wijeysundera, Duminda N.
Canada, Toronto
Toronto General Hospital
Wilson, Matt G.
United States, Washington, D.c.
Washington Hospital Center
Everingham, Kirsty
United Kingdom, London
The Royal London Hospital
Hewson, Russell W.
United Kingdom, London
The Royal London Hospital
Januszewska, Marta
United Kingdom, London
The Royal London Hospital
Phull, Mandeep Kaur
United Kingdom, London
The Royal London Hospital
Halliwell, Richard M.T.
Australia, Sydney
Westmead Hospital
Cope, Jennifer
Australia, Sydney
Westmead Hospital
Shulman, Mark A.
Australia, Melbourne
The Alfred
Myles, Paul S.
Australia, Melbourne
The Alfred
Ferguson, Marissa T.
Australia, Melbourne
The Alfred
MacMahon, Michael
Australia, Melbourne
The Alfred
Schmid, Werner
Austria, Vienna
Medizinische Universität Wien
Austria, Vienna
Allgemeines Krankenhaus Wien
Hiesmayr, Michael J.
Austria, Vienna
Medizinische Universität Wien
Wouters, Patrick F.
Belgium, Ghent
Universitair Ziekenhuis Gent
de Hert, Stefan G.
Belgium, Ghent
Universitair Ziekenhuis Gent
Lobo, Suzana Margareth Ajeje
Brazil, Sao Jose do Rio Preto
Faculdade de Medicina de São José do Rio Preto
Brazil, Sao Jose do Rio Preto
Hospital de Base
Fang, Xiangming
China, Nanjing
Nanjing Medical University
Rasmussen, Lars Melholt
Denmark, Copenhagen
Rigshospitalet
Vénara, Aurélien
France, Angers
Chu Angers
Sander, Michael
Germany, Giessen
Justus-liebig-universität Gießen
Koulenti, Despoina
Greece, Athens
Attikon University Hospital
Arvaniti, Kostoula
Greece, Thessaloniki
Papageorgiou General Hospital
Greece, Athens
Athens Naval Hospital
Chan, Matthew Tak Vai
Hong Kong, Hong Kong
Chinese University of Hong Kong
China, Hong Kong
Alice ho Miu Ling Nethersole Hospital
Hong Kong
Prince of Wales Hospital Hong Kong
Kulkarni, Atul
India, Mumbai
Tata Memorial Hospital
Chandra, Susilo
Indonesia, Depok
Universitas Indonesia
Tantri, Aida Rosita
Indonesia, Depok
Universitas Indonesia
Indonesia, Central Jakarta
Universitas Indonesia, Rsupn Dr. Cipto Mangunkusumo
Geddoa, Emad
United Kingdom, Northwood
Mount Vernon Hospital
Abbas, Muntadhar
United States, College Station
Texas A&m University
Della-Rocca, Giorgio
Italy, Udine
Università Degli Studi Di Udine
Italy, Udine
Policlinico Universitario, Udine
Sivasakthi, Datin
Malaysia, Kuala Lumpur
Kuala Lumpur Hospital
Mansor, Marzida Binti
Malaysia, Kuala Lumpur
Kuala Lumpur Hospital
Malaysia, Kuala Lumpur
University of Malaya Medical Centre
Luna, Pastor
Mexico, Mexico
Universidad Autónoma de la Ciudad de México
Bouwman, R. Arthur
Netherlands, Eindhoven
Catharina Ziekenhuis
Buhre, Wolfgang F.F.A.
Netherlands, Maastricht
Maastricht Universitair Medisch Centrum+
Beavis, Vanessa S.
New Zealand, Auckland
Auckland City Hospital
Campbell, Doug A.
New Zealand, Auckland
Auckland City Hospital
Short, Timothy G.
New Zealand, Auckland
Auckland City Hospital
Osinaike, Tunde
Nigeria, Lagos
General Hospital Lagos
Matos, Ricardo
Portugal, Porto
Sao Joao Hospital
Grigoras, Ioana
Romania, Iasi
Universitatea de Medicina si Farmacie Grigore T. Popa Din Iasi
Kirov, M. Yu
Russian Federation, Arkhangelsk
Northern State Medical University
Protsenko, Denis N.
Russian Federation, Moscow
Pirogov Russian National Research Medical University Rnrmu
Biccard, Bruce Mclure
South Africa, Durban
University of Kwazulu-natal
South Africa, Durban
Inkosi Albert Luthuli Central Hospital
Aldecoa, Cesar
Spain, Valladolid
Hospital Universitario Río Hortega
Chew, Michelle S.
Sweden, Lund
Lunds Universitet
Sweden, Halmstad
Hallands Sjukhus Halmstad
Hofer, Christoph Karl
Switzerland, Zurich
Stadtspital Triemli
Hübner, Martin
Switzerland, Lausanne
Centre Hospitalier Universitaire Vaudois
Ditai, James
Uganda, Mbale
Mbale Regional Referral Hospital
Szakmany, Tamas
United Kingdom, Cardiff
Cardiff University
United Kingdom, Llantrisant
Royal Glamorgan Hospital
Fleisher, Lee A.
United States, Philadelphia
University of Pennsylvania
Cherian, Ritchie
Australia, Blacktown
Blacktown & Mount Druitt Hospital
Currow, Helen
Australia, Blacktown
Blacktown & Mount Druitt Hospital
Kanathiban, Kathirgamanathan
Australia, Blacktown
Blacktown & Mount Druitt Hospital
Gillespie, David
Unknown Affiliation
Pathmanathan, Edward
Unknown Affiliation
Phillips, Katherine
Unknown Affiliation
Reynolds, Jenifer R.
Unknown Affiliation
Rowley, Joanne
Unknown Affiliation
Douglas, Jeanene Lizbeth
Australia, Newcastle
John Hunter Hospital
Kerridge, Ross K.
Australia, Newcastle
John Hunter Hospital
Garg, Sameer
Australia, Blacktown
Blacktown & Mount Druitt Hospital
Bennett, Michael H.
Australia, Sydney
Prince of Wales Hospital
Jain, Megha
Australia, Sydney
Prince of Wales Hospital
Alcock, David
Australia, Hobart
Royal Hobart Hospital
Terblanche, Nico C.S.
Australia, Hobart
Royal Hobart Hospital
Cotter, Rochelle
Australia, Melbourne
Royal Melbourne Hospital
Leslie, Kate E.
Australia, Melbourne
Royal Melbourne Hospital
Stewart, Marcelle
Australia, Melbourne
Royal Melbourne Hospital
Zingerle, Nicolette
Australia, Melbourne
Royal Melbourne Hospital
Clyde, Antony
Australia, Sydney
Royal North Shore Hospital
Hambidge, Oliver R.H.
Australia, Sydney
Royal North Shore Hospital
Rehak, Adam
Australia, Sydney
Royal North Shore Hospital
Cotterell, Sharon
Australia, Sydney
Royal Prince Alfred Hospital
Huynh, Wilson Binh Quan
Australia, Sydney
Royal Prince Alfred Hospital
McCulloch, Timothy James
Australia, Sydney
Royal Prince Alfred Hospital
Ben-Menachem, Erez
Australia, Sydney
St. Vincent's Hospital Sydney
Egan, Thomas
Australia, Sydney
St. Vincent's Hospital Sydney
Fellinger, Paul
Austria, Vienna
Allgemeines Krankenhaus Wien
Haselberger, Simone
Austria, Vienna
Allgemeines Krankenhaus Wien
Holaubek, Caroline
Austria, Vienna
Allgemeines Krankenhaus Wien
Lichtenegger, Paul
Austria, Vienna
Allgemeines Krankenhaus Wien
Scherz, Florian
Austria, Vienna
Allgemeines Krankenhaus Wien
Klug, Reinhold
Unknown Affiliation
Buerkle, Christian
Austria, Feldkirch
Landeskrankenhaus Feldkirch
Forget, Patrice
Belgium, Brussels
Cliniques Universitaires Saint-luc
Kahn, David A.
Belgium, Brussels
Cliniques Universitaires Saint-luc
Lois, Fernande Jane
Belgium, Brussels
Cliniques Universitaires Saint-luc
Momeni, Mona
Belgium, Brussels
Cliniques Universitaires Saint-luc
Pospiech, Audrey L.
Belgium, Brussels
Cliniques Universitaires Saint-luc
Steyaert, Arnaud
Belgium, Brussels
Cliniques Universitaires Saint-luc
Poelaert, Jan I.T.
Belgium, Jette
Universitair Ziekenhuis Brussel
Bouchez, Stefaan M.
Belgium, Ghent
Universitair Ziekenhuis Gent
Heyse, Björn E.K.
Belgium, Ghent
Universitair Ziekenhuis Gent
Jacobs, Tom Frans
Belgium, Ghent
Universitair Ziekenhuis Gent
Roels, Nathalie R.A.
Belgium, Ghent
Universitair Ziekenhuis Gent
Vanpeteghem, Caroline M.
Belgium, Ghent
Universitair Ziekenhuis Gent
Wyffels, Piet A.H.
Belgium, Ghent
Universitair Ziekenhuis Gent
Dylst, Dimitri
Belgium, Genk
Ziekenhuis Oost-limburg
Junior, Paulo do Nascimento
Brazil, Sao Paulo
Universidade Estadual Paulista Júlio de Mesquita Filho
Caser, Eliana Bernadete
Unknown Affiliation
Piras, Cláudio
Unknown Affiliation
Funk, Duane J.
Canada, Winnipeg
Health Sciences Centre Winnipeg
George, Ronald B.
Canada, Halifax
Iwk Health Centre
Jones, Philip M.G.
Canada, London
London Health Sciences Centre
Hall, Richard I.
Canada, Halifax
Qeii Health Sciences Centre
Hare, Gregory M.T.
Canada, Toronto
Saint Michael's Hospital University of Toronto
Choi, Stephen Deanne
Canada, Toronto
Sunnybrook Health Sciences Centre
McCartney, Colin J.L.
Canada, Toronto
Sunnybrook Health Sciences Centre
Carroll, Jo Ann
Unknown Affiliation
Perlas, Anahi
Canada, Toronto
Toronto Western Hospital University of Toronto
Yuan, Fang
China, Tianjin
Tianjin Medical University
Rasmussen, Bodil Steen
Denmark, Aalborg
Aalborg Universitetshospital
Larsen, Michael Hareskov
Denmark, Odense
Odense Universitetshospital
Rasmussen, Lars Simon
Denmark, Copenhagen
Rigshospitalet
Belœil, Hélène
France, Rennes
Centre Hospitalier Universitaire de Rennes
Lasocki, Sigismond
France, Angers
Chu Angers
Legouge, Marie Lim
France, Paris
Chu, Paris
Tesnier̀e, Antoine
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Mutter, Didier
France, Strasbourg
Les Hôpitaux Universitaires de Strasbourg
Ouaïssi, Mehdi
France, Marseille
Hopital la Timone
Régimbeau, Jean Marc
France, Amiens
Chu Amiens Picardie
Lebuffe, Gilles R.
France, Lille
Chu Lille
Wittmann, Maria
Germany, Bonn
Universitätsklinikum Bonn
Goebel, Ulrich
Germany, Freiburg Im Breisgau
Universitätsklinikum Freiburg
Harris, Sarah E.
Germany, Freiburg Im Breisgau
Universitätsklinikum Freiburg
Gkiokas, Georgios A.
Greece, Athens
Aretaio Hospital
Georgiou, Georgios K.
Greece, Xanthi
General Hospital of Xanthi
Tsigou, Evdoxia
Unknown Affiliation
Mainas, Efstratios
Greece, Athens
Hippokration General Hospital
Ioannidis, Orestis M.
Greece, Thessaloniki
Papageorgiou General Hospital
Stamatiou, Konstantinos
Unknown Affiliation
Andreou, Alexandros G.
Greece, Alexandroupoli
University Hospital of Alexandroupolis
Koulouras, Vasilios P.
Greece, Ioannina
University General Hospital of Ioannina
Papadopoulos, Dimitrios B.
Greece, Ioannina
University General Hospital of Ioannina
Stamoulis, Konstantinos G.
Greece, Larissa
University Hospital of Larissa
Koo, Emily Gar Yee
China, Hong Kong
Pamela Youde Nethersole Eastern Hospital
Shah, Bhagyesh Ashwinkumar
India, Ahmedabad
Cims Hospital
Divatia, Jigeeshu Vasishtha
India, Mumbai
Tata Memorial Hospital
Kulkarni, Atul Prabhakar
India, Mumbai
Tata Memorial Hospital
Mishra, Sanghamitra S.
India, Mumbai
Tata Memorial Hospital
Chandra, Susilo
Indonesia, Central Jakarta
Universitas Indonesia, Rsupn Dr. Cipto Mangunkusumo
Spadaro, S.
Italy, Cona
Azienda Ospedaliero-universitaria Di Ferrara
Roasio, Agostino
Unknown Affiliation
Bignami, Elena Giovanna
Unknown Affiliation
Cabrini, Luca
Unknown Affiliation
Landoni, Giovanni
Unknown Affiliation
Winterton, Dario
Unknown Affiliation
Zangrillo, Alberto
Unknown Affiliation
Gastaldi, Christian
Italy, Gallarate
St. Antonio Abate Hospital
Pata, Francesco
Italy, Gallarate
St. Antonio Abate Hospital
Joseph, James
Unknown Affiliation
Statistics
Citations: 15
Authors: 170
Affiliations: 192
Identifiers
Doi:
10.1002/bjs.11025
ISSN:
00071323
Research Areas
Health System And Policy
Study Design
Cohort Study
Grounded Theory
Study Approach
Quantitative