Definition and Classification of Postoperative Complications After Cardiac Surgery: Pilot Delphi Study

Linda Lapp; Matt-Mouley Bouamrane; Marc Roper; Kimberley Kavanagh; Stefan Schraag

doi:10.2196/39907

Definition and Classification of Postoperative Complications After Cardiac Surgery: Pilot Delphi Study

JMIR Perioper Med. 2022 Oct 12;5(1):e39907. doi: 10.2196/39907.

Authors

Linda Lapp¹, Matt-Mouley Bouamrane², Marc Roper¹, Kimberley Kavanagh³, Stefan Schraag⁴

Affiliations

¹ Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom.
² Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
³ Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom.
⁴ Department of Anaesthesia and Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, United Kingdom.

PMID: 36222812
PMCID: PMC9607909
DOI: 10.2196/39907

Abstract

Background: Postoperative complications following cardiac surgery are common and represent a serious burden to health services and society. However, there is a lack of consensus among experts on what events should be considered as a "complication" and how to assess their severity.

Objective: This study aimed to consult domain experts to pilot the development of a definition and classification system for complications following cardiac surgery with the goal to allow the progression of standardized clinical processes and systems in cardiac surgery.

Methods: We conducted a Delphi study, which is a well-established method to reach expert consensus on complex topics. We sent 2 rounds of surveys to domain experts, including cardiac surgeons and anesthetists, to define and classify postoperative complications following cardiac surgery. The responses to open-ended questions were analyzed using a thematic analysis framework.

Results: In total, 71 and 37 experts' opinions were included in the analysis in Round 1 and Round 2 of the study, respectively. Cardiac anesthetists and cardiac critical care specialists took part in the study. Cardiac surgeons did not participate. Experts agreed that a classification for postoperative complications for cardiac surgery is useful, and consensus was reached for the generic definition of a postoperative complication in cardiac surgery. Consensus was also reached on classification of complications according to the following 4 levels: "Mild," "Moderate," "Severe," and "Death." Consensus was also reached on definitions for "Mild" and "Severe" categories of complications.

Conclusions: Domain experts agreed on the definition and classification of complications in cardiac surgery for "Mild" and "Severe" complications. The standardization of complication identification, recording, and reporting in cardiac surgery should help the development of quality benchmarks, clinical audit, care quality assessment, resource planning, risk management, communication, and research.

Keywords: Delphi study; anesthetists; cardiac; cardiac surgery; cardiology; clinical; communication; complications; development; health services; morbidity; pilot; postoperative; postoperative complications; quality; research; resources; risk management; society; surgeons; surgery; system.

©Linda Lapp, Matt-Mouley Bouamrane, Marc Roper, Kimberley Kavanagh, Stefan Schraag. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 12.10.2022.