REPORTING AND GRADING OF COMPLICATIONS AFTER UROLOGIC SURGICAL PROCEDURES: AN AD HOC EAU GUIDELINES PANEL ASSESSMENT AND RECOMMENDATIONS

Czech version

Authors: D. Mitropoulos ¹; W. Artibani ²; M. Graefen ³; M. Remzi ⁴; M. Roupręt ⁵; M. Truss ⁶
Authors‘ workplace: 1st Department of Urology, University of Athens Medical School, Athens, Greece ¹; Department of Biomedical and Surgical Sciences, Urology Clinic, University of Verona, Verona, Italy ²; Martini-Clinic, Prostate Cancer Centre, University Hamburg-Eppendorf, Hamburg, Germany ³; Department of Urology, LandesklinikumKorneuburg, Korneuburg, Austria ⁴; Academic Department of Urology, Hospital Pitié-Salpétriére, Assistance PubliqueHopitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France ⁵; Department of Urology, Klinikum Dortmund GmbH, Dortmund, Germany ⁶
Published in: Urol List 2012; 10(1): 75-84

Overview

Context:
The incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology.

Objective:
To review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes.

Evidence acquisition:
Standardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999–2000 and 2009–2010. Data identification for the systematic assessment of the Clavien-Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms.

Evidence synthesis:
The systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien-Dindo system. The latter system was not properly used in 72 papers (35.3%).

Conclusions:
Uniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria. Take Home Message: Although there is a demonstrable increase in the awareness and use of standardised reporting of complications in the literature, no standard guidelines or criteria exist for reporting surgical complications in the area of urology. The authors present a series of practical recommendations for reporting and grading complications that could help to improve patient care and the quality of scientific publications.

Key words:
postoperative complications, urology, reporting, grading, Clavien-Dindo, EAU, recommendations, standardization

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Article was published in

Urological Journal

2012 Issue 1