Vol 72, No 4 (2022)
Invited editorial
Published online: 2022-08-22
Evaluation of postoperative complications in the older population
12
, 3
, 3
Nowotwory. Journal of Oncology 2022;72(4):250-257.
Abstract
Evaluation of the frequency and severity of postoperative complications is an integral part of establishing the clinical utility of a specific treatment. They define the possible consequences resulting from the chosen method of treatment, and thus the potential risks associated with this choice. Thanks to the analysis of complications, it is possible to evaluate patients’ safety, identify a problem in the course of surgery within a given hospital and surgical team or carry a financial analysis. Not only is the frequency of occurrence important, but so is the severity of complications. Therefore, in recent years we have seen the development of several new tools for assessing postoperative complications such as the Clavien-Dindo scale, the Accordion Severity Grading System, the Postoperative Morbidity Index or the Comprehensive Complication Index. Analysis of the above-mentioned scales may contribute to the development of clear algorithms for the management of older patients at increased risk of severe complications and higher mortality, which subsequently may lead to increased efficacy and safer treatment in this population.
Keywords: postoperative complicationselderlyAccordion Severity Grading SystemPostoperative Morbidity IndexComprehensive Complication Index
References
- Krosch TCK, D'Cunha J. Comparing apples to apples: a call for unification of complication reporting across health systems. Semin Thorac Cardiovasc Surg. 2010; 22(4): 271–273.
- Martin RCG, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002; 235(6): 803–813.
- Brennan MF. Postoperative complication reporting: more than mortality and morbidity. Ann Surg. 2013; 258(1): 8–9.
- Kenig J. Oncogeriatrics (part 2.). Normal and pathological ageing. Nowotwory. Journal of Oncology. 2019; 69(3-4): 146–149.
- Fried TR, Van Ness PH, Byers AL, et al. Changes in preferences for life-sustaining treatment among older persons with advanced illness. J Gen Intern Med. 2007; 22(4): 495–501.
- Kenig J. Oncogeriatrics (part 4.) Pre-operative assessment of elderly patients with cancer. Nowotwory. Journal of Oncology. 2020; 70(1): 16–19.
- Skorus U, Kenig J. Oncogeriatrics (part 5.) The role of comorbidities in older patients with cancer. Nowotwory Journal of Oncology. 2020; 70(2): 54–59.
- Kristjansson SR, Nesbakken A, Jordhøy MS, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010; 76(3): 208–217.
- Kenig J. Oncogeriatrics (part 1.). Frailty in older adults with cancer. Nowotwory. Journal of Oncology. 2019; 69(2): 55–57.
- Kenig J. Oncogeriatrics (part 3.) Influence of surgical trauma on older patients. Nowotwory. Journal of Oncology. 2019; 69(5-6): 163–167.
- Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111(5): 518–526.
- Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009; 250(2): 177–186.
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2): 205–213.
- Li J, Moustafa M, Freiwald-Bibiza E, et al. Is It Feasible to Standardize a Composite Postoperative Complication Reporting System for Liver Resection? J Gastrointest Surg. 2020; 24(12): 2748–2755.
- Mitropoulos D, Artibani W, Biyani CS, et al. Validation of the Clavien-Dindo Grading System in Urology by the European Association of Urology Guidelines Ad Hoc Panel. Eur Urol Focus. 2018; 4(4): 608–613.
- Radosa MP, Meyberg-Solomayer G, Radosa J, et al. Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification. Geburtshilfe Frauenheilkd. 2014; 74(8): 752–758.
- Jung MiR, Park YK, Seon JW, et al. Definition and classification of complications of gastrectomy for gastric cancer based on the accordion severity grading system. World J Surg. 2012; 36(10): 2400–2411.
- Porembka MR, Hall BL, Hirbe M, et al. Quantitative weighting of postoperative complications based on the accordion severity grading system: demonstration of potential impact using the american college of surgeons national surgical quality improvement program. J Am Coll Surg. 2010; 210(3): 286–298.
- Low DE, Kuppusamy M, Hashimoto Y, et al. Comparing complications of esophagectomy and pancreaticoduodenectomy and potential impact on hospital systems utilizing the accordion severity grading system. J Gastrointest Surg. 2010; 14(11): 1646–1652.
- Carrott PW, Markar SR, Kuppusamy MK, et al. Accordion severity grading system: assessment of relationship between costs, length of hospital stay, and survival in patients with complications after esophagectomy for cancer. J Am Coll Surg. 2012; 215(3): 331–336.
- Strasberg S, Hall B. Postoperative Morbidity Index: A Quantitative Measure of Severity of Postoperative Complications. J Am Coll Surg. 2011; 213(5): 616–626.
- Tahkola K, Väyrynen V, Kellokumpu I, et al. Critical evaluation of quality of hepatopancreatic surgery in a medium-volume center in Finland using the Accordion Severity Grading System and the Postoperative Morbidity Index. J Gastrointest Oncol. 2020; 11(4): 724–737.
- Datta J, Lewis RS, Strasberg SM, et al. Quantifying the burden of complications following total pancreatectomy using the postoperative morbidity index: a multi-institutional perspective. J Gastrointest Surg. 2015; 19(3): 506–515.
- Lee MK, Lewis RS, Strasberg SM, et al. Defining the post-operative morbidity index for distal pancreatectomy. HPB (Oxford). 2014; 16(10): 915–923.
- Beilan J, Strakosha R, Palacios DA, et al. The Postoperative Morbidity Index: a quantitative weighing of postoperative complications applied to urological procedures. BMC Urol. 2014; 14: 1.
- American College of Surgeons NSQIP Data User Guide 2015.
- Epelboym I, Gawlas I, Lee JA, et al. Limitations of ACS-NSQIP in reporting complications for patients undergoing pancreatectomy: underscoring the need for a pancreas-specific module. World J Surg. 2014; 38(6): 1461–1467.
- Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013; 258(1): 1–7.
- Slankamenac K, Nederlof N, Pessaux P, et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg. 2014; 260(5): 757–62; discussion 762.
- Boney O, Moonesinghe R, Grocott M. Reply to Slankamenac et al's Comprehensive Complication Index Validation Study. Ann Surg. 2016; 264(2): e11.
- Kim TH, Suh YS, Huh YJ, et al. The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery. Gastric Cancer. 2018; 21(1): 171–181.
- de la Plaza Llamas R, Hidalgo Vega Á, Latorre Fragua RA, et al. The Cost of Postoperative Complications and Economic Validation of the Comprehensive Complication Index: Prospective Study. Ann Surg. 2021; 273(1): 112–120.
- Smeyers KM, Slankamenac K, Houben B, et al. Comparison of the Clavien-Dindo and Comprehensive Complication Index systems for grading of surgical complications after colorectal resections. Acta Chir Belg. 2021 [Epub ahead of print]: 1–8.
- Clavien PA, Vetter D, Staiger RD, et al. The Comprehensive Complication Index (CCI®): Added Value and Clinical Perspectives 3 Years "Down the Line". Ann Surg. 2017; 265(6): 1045–1050.
- Kenig J, Mituś J, Rapacz K. Oncogeriatrics (part 6.). The usefulness of routine preoperative investigations in the qualification of an older patient for elective surgery. Nowotwory. Journal of Oncology. 2020; 70(3): 101–104.
- Kenig J, Szabat K. Oncogeriatrics (part 7.). Geriatric assessment for older patients with cancer. Nowotwory. Journal of Oncology. 2020; 70(4): 153–157.
- Story DA. Postoperative complications in elderly patients and their significance for long-term prognosis. Curr Opin Anaesthesiol. 2008; 21(3): 375–379.
- Sieber FE, Barnett SR. Preventing postoperative complications in the elderly. Anesthesiol Clin. 2011; 29(1): 83–97.
- Gani F, Hundt J, Makary MA, et al. Financial Impact of Postoperative Complication Following Hepato-Pancreatico-Biliary Surgery for Cancer. Ann Surg Oncol. 2016; 23(4): 1064–1070.
- Tahiri M, Sikder T, Maimon G, et al. The impact of postoperative complications on the recovery of elderly surgical patients. Surg Endosc. 2016; 30(5): 1762–1770.
- Story DA, Leslie K, Myles PS, et al. REASON Investigators, Australian and New Zealand College of Anaesthetists Trials Group. Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study. Anaesthesia. 2010; 65(10): 1022–1030.
- Hamel MB, Henderson WG, Khuri SF, et al. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005; 53(3): 424–429.
- Serafim RB, Dutra MF, Saddy F, et al. Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes. Ann Intensive Care. 2012; 2(1): 51.
- Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004; 199(5): 762–772.
- Gleason LJ, Schmitt EM, Kosar CM, et al. Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults. JAMA Surg. 2015; 150(12): 1134–1140.
- Kenig J. Oncogeriatrics (part 8.). Frailty screening tools. Nowotwory. Journal of Oncology. 2020; 70(5): 184–186.
- Kenig J, Krzeszowiak J, Kupniewski K. Postoperative functional results of older patients after pancreas and liver surgery. Nowotwory. Journal of Oncology. 2022; 72(3): 202–206.
- Artiles-Armas M, Roque-Castellano C, Conde-Martel A, et al. The Comprehensive Complication Index is Related to Frailty in Elderly Surgical Patients. J Surg Res. 2019; 244: 218–224.
- Wang D, Zhang J, Bai Z, et al. Associations of Postoperative Complications Assessed by Clavien-Dindo Classification and Comprehensive Complication Index with Long-Term Overall Survival in Elderly Patients after Radical CRC Resection. Clin Interv Aging. 2020; 15: 1939–1949.
- Carli F, Bousquet-Dion G, Awasthi R, et al. Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer: A Randomized Clinical Trial. JAMA Surg. 2020; 155(3): 233–242.
- Ommundsen N, Nesbakken A, Wyller TB, et al. Post-discharge complications in frail older patients after surgery for colorectal cancer. Eur J Surg Oncol. 2018; 44(10): 1542–1547.
- Kinaci E, Sevinc MM, Bayrak S, et al. Is the classification of intraoperative complications (CLASSIC) related to postoperative course? Int J Surg. 2016; 29: 171–175.