Appraisal of Intraoperative Adverse Events to Improve Postoperative Care

Larsa Gawria; Ahmed Jaber; Richard Peter Gerardus Ten Broek; Gianmaria Bernasconi; Rachel Rosenthal; Harry Van Goor; Salome Dell-Kuster

doi:10.3390/jcm12072546

Appraisal of Intraoperative Adverse Events to Improve Postoperative Care

J Clin Med. 2023 Mar 28;12(7):2546. doi: 10.3390/jcm12072546.

Authors

Larsa Gawria^{1

2}, Ahmed Jaber^{1

3}, Richard Peter Gerardus Ten Broek¹, Gianmaria Bernasconi⁴, Rachel Rosenthal⁵, Harry Van Goor¹, Salome Dell-Kuster^{3

6

7}

Affiliations

¹ Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands.
² Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, 4051 Basel, Switzerland.
³ Department of Surgery, Yitzhak Shamir Medical Centre, Tel Aviv 7030083, Israel.
⁴ Clinic for Anesthesiology and Pain Therapy, Hospital of Fribourg, 1752 Fribourg, Switzerland.
⁵ Faculty of Medicine, University of Basel, 4001 Basel, Switzerland.
⁶ Clinic for Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland.
⁷ Department of Clinical Research, University of Basel, 4031 Basel, Switzerland.

Abstract

Background: Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications.

Methods: All patients enrolled in the multicenter ClassIntra^® validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other's ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI^®), a weighted sum of all postoperative complications according to the Clavien-Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra^® on CCI^® was assessed with a multivariable mixed-effects generalized linear regression analysis.

Results: Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding (n = 217, 28%), hypotension (n = 118, 15%), and organ injury (n = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI^® was observed.

Conclusion: Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade.

Keywords: classification of intraoperative adverse events; intraoperative adverse events; intraoperative complications; origin of Intraoperative adverse events.

Grants and funding

This research received no external funding.