Comprehensive Analysis of Surgical Complications at a University Hospital

Over the 6‑month period covering April 2010 to September 2010, all patients admitted to one of our patient wards at the Division of General Surgery, Department of Surgery, Medical University of Vienna were included in this study.
The Division of General Surgery in our university hospital consists of the following teams and specializations: colorectal surgery, hepatobiliary surgery, endocrine surgery, upper gastrointestinal (GI) surgery (esophageal and stomach surgery), bariatric surgery, breast surgery, and pancreatic surgery.
The patient data were extracted by reviewing all discharge letters from that period taken from the digital archives.
Overall, 517 patients were admitted over this period, some repeatedly, leading to a total of 817 admissions. These 517 patients underwent 463 operations. The complications of these operations were then rated according to the Clavien-Dindo classification (Table 1). For easier use, the suffix “d” for permanent disability was not drawn upon.Table 1

Clavien-Dindo classification

Grade	Definition
Grade I	Any deviation from the normal postoperative course without the need for pharmacological treatment, or surgical, endoscopic, and radiological interventions.Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside
Grade II	Requiring pharmacological treatment with drugs other than such allowed for grade I complications.Blood transfusions and total parenteral nutrition are also included
Grade III	Requiring surgical, endoscopic, or radiological intervention
Grade IIIa	Intervention not under general anesthesia
Grade IIIb	Intervention under general anesthesia
Grade IV	Life-threatening complication (including central nervous system complications) requiring IC/ICU management
Grade IVa	Single organ dysfunction (including dialysis)
Grade IVb	Multiorgan dysfunction
Grade V	Death of a patient

According to Dindo et al. [6 (link)]

IC intermediate care, ICU intensive care unit

The operations were sorted according to the complexity ranking (eight groups) in the accounting system of the Austrian Chamber of Physicians (Table 2; [8 ]).Table 2

Operation groups (complexity according to the Austrian Chamber of Physicians)

Operation group	Examples
I	Abscess incisions, secondary sutures, proctoscopy, skin biopsy
II	Excisions of atheromas, fibromas, lipomas, incisions of anal abscesses
III	Toe amputation, small lymph node extirpation, thoracic drainage, colonoscopy
IV	Tracheotomy, appendectomy, hernia operation, colostomy, gastrostomy, ERCP
V	Gastroenterostomy, interventions for recurrent hernia, Cimino fistula, radical varicose vein stripping
VI	Strumectomy, cholecystectomy, splenectomy, hemicolectomy, reduction mammoplasty
VII	Partial pancreatectomy, subtotal colectomy, subsegmental and large liver resections
VIII	Esophageal resection, open surgery of aortic aneurysms, organ transplantation