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Abbott TEF, Greaves KE, Patel A, Ahmad T, Haddow J, Futier E, Biais M, Slim K, Pearse RM, Pearse RM, Beattie S, Clavien PA, Demartines N, Fleisher LA, Grocott M, Haddow J, Hoeft A, Holt P, Moreno R, Pritchard N, Rhodes A, Wijeysundera D, Wilson M, Ahmed T, Everingham K, Hewson R, Januszewska M, Pearse RM, Phull MK, Halliwell R, Shulman M, Myles P, Schmid W, Hiesmayr M, Wouters P, Hert S, Lobo S, Beattie S, Wijeysundera D, Fang X, Rasmussen L, Futier E, Biais M, Venara A, Slim K, Sander M, Koulenti D, Arvaniti K, Chan M, Kulkarni A, Chandra S, Tantri A, Geddoa E, Abbas M, Della Rocca G, Sivasakthi D, Mansor M, Luna P, Bouwman A, Buhre W, Beavis V, Campbell D, Short T, Osinaike T, Matos R, Grigoras I, Kirov M, Protsenko D, Biccard B, Aldecoa C, Chew M, Hofer C, Hubner M, Ditai J, Szakmany T, Fleisher L, Ferguson M, MacMahon M, Shulman M, Cherian R, Currow H, Kanathiban K, Gillespie D, Pathmanathan E, Phillips K, Reynolds J, Rowley J, Douglas J, Kerridge R, Currow H, Garg S, Bennett M, Jain M, Alcock D, Terblanche N, Cotter R, Leslie K, Stewart M, Zingerle N, Clyde A, et alAbbott TEF, Greaves KE, Patel A, Ahmad T, Haddow J, Futier E, Biais M, Slim K, Pearse RM, Pearse RM, Beattie S, Clavien PA, Demartines N, Fleisher LA, Grocott M, Haddow J, Hoeft A, Holt P, Moreno R, Pritchard N, Rhodes A, Wijeysundera D, Wilson M, Ahmed T, Everingham K, Hewson R, Januszewska M, Pearse RM, Phull MK, Halliwell R, Shulman M, Myles P, Schmid W, Hiesmayr M, Wouters P, Hert S, Lobo S, Beattie S, Wijeysundera D, Fang X, Rasmussen L, Futier E, Biais M, Venara A, Slim K, Sander M, Koulenti D, Arvaniti K, Chan M, Kulkarni A, Chandra S, Tantri A, Geddoa E, Abbas M, Della Rocca G, Sivasakthi D, Mansor M, Luna P, Bouwman A, Buhre W, Beavis V, Campbell D, Short T, Osinaike T, Matos R, Grigoras I, Kirov M, Protsenko D, Biccard B, Aldecoa C, Chew M, Hofer C, Hubner M, Ditai J, Szakmany T, Fleisher L, Ferguson M, MacMahon M, Shulman M, Cherian R, Currow H, Kanathiban K, Gillespie D, Pathmanathan E, Phillips K, Reynolds J, Rowley J, Douglas J, Kerridge R, Currow H, Garg S, Bennett M, Jain M, Alcock D, Terblanche N, Cotter R, Leslie K, Stewart M, Zingerle N, Clyde A, Hambidge O, Rehak A, Cotterell S, Huynh WBQ, McCulloch T, Ben-Menachem E, Egan T, Cope J, Halliwell R, Fellinger P, Haselberger S, Holaubek C, Lichtenegger P, Scherz F, Schmid W, Hoffer F, Cakova V, Eichwalder A, Fischbach N, Klug R, Schneider E, Vesely M, Wickenhauser R, Grubmueller KG, Leitgeb M, Lang F, Toro N, Bauer M, Laengle F, Mayrhofer T, Buerkle C, Forstner K, Germann R, Rinoesl H, Schindler E, Trampitsch E, Fritsch G, Szabo C, Bidgoli J, Verdoodt H, Forget P, Kahn D, Lois F, Momeni M, Prégardien C, Pospiech A, Steyaert A, Veevaete L, De Kegel D, De Jongh K, Foubert L, Smitz C, Vercauteren M, Poelaert J, Van Mossevelde V, Abeloos J, Bouchez S, Coppens M, De Baerdemaeker L, Deblaere I, De Bruyne A, De Hert S, Fonck K, Heyse B, Jacobs T, Lapage K, Moerman A, Neckebroek M, Parashchanka A, Roels N, Van Den Eynde N, Vandenheuvel M, Van Limmen J, Vanluchene A, Vanpeteghem C, Wouters P, Wyffels P, Huygens C, Vandenbempt P, Van de Velde M, Dylst D, Janssen B, Schreurs E, Aleixo FB, Candido K, Batista HD, Guimarães M, Guizeline J, Hoffmann J, Lobo SM, Lobo FR, Nascimento V, Nishiyama K, Pazetto L, Souza D, Rodrigues RS, Santos AMV, Jardim J, Silva J, Nascimento Junior P, Baio TH, Castro GIP, Oliveira HRW, Amendola CP, Cardoso G, Ortega D, Brotto AF, De Oliveira MC, Réa-Neto Á, Dias F, Azambuja P, Knibel MF, Martins A, Almeida W, Neto CN, Tardelli MA, Caser E, Machado M, Aguzzoli C, Baldisserotto S, Tabajara FB, Bettega F, Júnior LHCR, Gasperi J, Faina L, Nolasco MF, Costa Fischer BF, Campos Ferreira MF, Hartmann C, Kliemann M, Ribeiro GLH, Fraga JM, Netto TM, Pozza LV, Wendling PR, Azevedo C, Garcia J, Lopes M, Maia B, Maselli P, Melo R, Mendes W, Neves M, Ney J, Piras C, Applewhaite C, Carr A, Chow L, Duttchen K, Foglia J, Greene M, Hinther A, Houston K, McCormick TJ, Mikhayel J, Montasser S, Ragan A, Suen A, Woolsey A, Yu HC, Funk D, Kowalski S, Legaspi R, McDonald H, Siddiqui F, Pridham J, Rowe B, Sampson S, Thiessen B, Zbitnew G, Bernard A, George R, Jones P, Moor R, Siddiqui N, Wolfer A, Tran D, Winch D, Dobson G, Hinther A, McCormick T, Montasser O, Suen A, Woolsey A, Bernard A, George R, Hall R, Bernard A, George R, Hall R, Applewhaite C, Baghirzada L, McCormick TJ, Suen A, Dai SY, Hare G, Lee E, Shastri U, Tsui A, Yagnik A, Alvares D, Choi S, Dwyer H, Flores K, McCartney C, Somascanthan P, Beattie S, Carroll J, Pazmino-Canizares J, Wijeysundera D, Wolfer A, Ami N, Chan V, Perlas A, Argue R, Lavis K, Mayson K, Cao Y, Gao H, Hu T, Lv J, Yang J, Yang Y, Zhong Y, Zhou J, Zou X, He M, Li X, Luo D, Wang H, Yu T, Chen L, Wang L, Cai Y, Cao Z, Li Y, Lian J, Sun H, Wang S, Wang Z, Wang K, Zhu Y, Du X, Fan H, Fu Y, Huang L, Huang Y, Hwan H, Luo H, Qu PS, Tao F, Wang Z, Wang G, Wang S, Zhang Y, Zhang X, Chen C, Wang W, Liu Z, Fan L, Tang J, Chen Y, Chen Y, Han Y, Huang C, Liang G, Shen J, Wang J, Yang Q, Zhen J, Zhou H, Chen J, Chen Z, Li X, Meng B, Ye H, Zhang X, Bi Y, Cao J, Guo F, Lin H, Liu Y, Lv M, Shi P, Song X, Sun C, Sun Y, Wang Y, Wang S, Zhang M, Chen R, Hou J, Leng Y, Meng QT, Qian L, Shen ZY, Xia ZY, Xue R, Zhang Y, Zhao B, Zhou XJ, Chen Q, Guo H, Guo Y, Qi Y, Wang Z, Wei J, Zhang W, Zheng L, Bao Q, Chen Y, Chen Y, Fei Y, Hu N, Hu X, Lei M, Li X, Lv X, Lv J, Miao F, Ouyang L, Qian L, Shen C, Sun Y, Wang Y, Wang D, Wu C, Xu L, Yuan J, Zhang L, Zhang H, Zhang Y, Zhao J, Zhao C, Zhao L, Zheng T, Zhou D, Zhou H, Zhou C, Lu K, Zhao T, He C, Chen H, Chen S, Cheng B, He J, Jin L, Li C, Li H, Pan Y, Shi Y, Wen XH, Wu S, Xie G, Zhang K, Zhao B, Lu X, Chen F, Liang Q, Lin X, Ling Y, Liu G, Tao J, Yang L, Zhou J, Chen F, Feng Y, Hou B, Lin J, Liu M, Luo F, Shi X, Xiong Y, Xu L, Yang S, Zhang Q, Zhang H, Zhao W, Zhao W, Yun B, Chen L, Chen S, Dai Q, Geng W, Han K, He X, Huang L, Ji B, Jia D, Jin S, Li Q, Liang D, Luo S, Lwang L, Mo Y, Pan Y, Qi X, Qian M, Qin J, Ren Y, Shi Y, Wang J, Wang J, Wang L, Xie J, Yan Y, Yao Y, Zhang M, Zhao J, Zhuang X, Ai Y, Du F, He L, Huang L, Li Z, Li H, Li Y, Li L, Meng S, Yuan Y, Zhang E, Zhang J, Zhao S, Ji Z, Pei L, Wang L, Chen C, Dong B, Li J, Miao Z, Mu H, Qin C, Su L, Wen Z, Xie K, Yu Y, Yuan F, Hu X, Zhang Y, Xiao W, Zhu Z, Dai Q, Fu K, Hu R, Hu X, Huang S, Li Y, Liang Y, Yu S, Guo Z, Jing Y, Tang N, Wu J, Yuan D, Zhang R, Zhao X, Li Y, Bai HP, Liu CX, Liu FF, Ren W, Wang XL, Xu GJ, Hu N, Li B, Ou Y, Tang Y, Yao S, Zhang S, Kong CC, Liu B, Wang T, Xiao W, Lu B, Xia Y, Zhou J, Cai F, Chen P, Hu S, Wang H, Wu J, Xu Q, Hu L, Jing L, Li J, Li B, Liu Q, Liu Y, Lu X, Peng ZD, Qiu X, Ren Q, Tong Y, Wang Z, Wang J, Wen Y, Wu Q, Xia J, Xie J, Xiong X, Xu S, Yang T, Ye H, Yin N, Yuan J, Zeng Q, Zhang B, Zheng K, Cang J, Chen S, Du F, Fan Y, Fu S, Ge X, Guo B, Huang W, Jiang L, Jiang X, Jin L, Liu Y, Pan Y, Ren Y, Shan Q, Wang J, Wang F, Wu C, Zhang X, Christiansen IC, Granum SN, Rasmussen BS, Daugaard M, Gambhir R, Steingrímsdóttir GE, Jensen-Gadegaard P, Olsen KS, Siegel H, Eskildsen KZ, Gätke MR, Wibrandt I, Heintzelmann SB, Lange KHW, Lundsgaard RS, Amstrup-Hansen L, Hovendal C, Larsen M, Lenstrup M, Kobborg T, Larsen JR, Pedersen AB, Larsen JR, Smith SH, Oestervig RM, Rasmussen L, Afshari A, Andersen C, Ekelund K, Secher EL, Brandsborg B, Beloeil H, Lasocki S, Venara A, Biais M, Ouattara A, Sineus M, Molliex S, Legouge ML, Wallet F, Tesniere A, Gaudin C, Lehur P, Forsans E, Rudnicki S, Maudet VS, Mutter D, Sojod G, Ouaissi M, Regimbeau JM, Futier E, Desbordes J, Comptaer N, Manser D, Ethgen S, Lebuffe G, Auer P, Härtl C, Deja M, Legashov K, Sonnemann S, Wiegand-Loehnert C, Falk E, Habicher M, Angermair S, Laetsch B, Schmidt K, Sonnemann S, Von Heymann C, Ramminger A, Jelschen F, Pabel S, Weyland A, Czeslick E, Gille J, Malcharek M, Sablotzki A, Lueke K, Wetzel P, Weimann J, Lenhart FP, Reichle F, Schirmer F, Hüppe M, Klotz K, Nau C, Schön J, Mencke T, Wasmund C, Bankewitz C, 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Conde C, Funk B, Hall R, Hopkins T, Olaleye O, Omer O, Pender M, Porto A, Stevens A, Waweru P, Yeh E, Bodansky D, Evans A, Kleopoulos S, Maril R, Mathney E, Sanchez A, Tinuoye E, Bateman B, Eng K, Jiang N, Ladha K, Needleman J, Chen LL, Chen LL, Lane R, Robinowitz D, Ghushe N, Irshad M, Patel S, Takemoto S, Wallace A, Mazzeffi M, Rock P, Wallace K, Zhu X, Chua P, Fleisher L, Mattera M, Sharar R, Thilen S, Treggiari M, Morgan A, Sofjan I, Subramaniam K, Avidan M, Maybrier H, Muench M, Wildes T. Prospective observational cohort study on grading the severity of postoperative complications in global surgery research. Br J Surg 2019; 106:e73-e80. [PMID: 30620066 DOI: 10.1002/bjs.11025] [Show More Authors] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 12/20/2022]
Abstract
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.
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