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Vol 72, No 4 (2022)
Invited editorial
Published online: 2022-08-22
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Evaluation of postoperative complications in the older population

Mateusz Sitkowski12, Jakub Kenig3
DOI: 10.5603/NJO.2022.0039
·
Nowotwory. Journal of Oncology 2022;72(4):250-257.
Affiliations
  1. Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
  2. III Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
  3. Department of General, Gastrointestinal, Oncologic Surgery and Transplantology, I Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland

open access

Vol 72, No 4 (2022)
Invited editorial
Published online: 2022-08-22

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.

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.

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Keywords

postoperative complications; elderly; Accordion Severity Grading System; Postoperative Morbidity Index; Comprehensive Complication Index

About this article
Title

Evaluation of postoperative complications in the older population

Journal

Nowotwory. Journal of Oncology

Issue

Vol 72, No 4 (2022)

Article type

Invited editorial

Pages

250-257

Published online

2022-08-22

Page views

3834

Article views/downloads

237

DOI

10.5603/NJO.2022.0039

Bibliographic record

Nowotwory. Journal of Oncology 2022;72(4):250-257.

Keywords

postoperative complications
elderly
Accordion Severity Grading System
Postoperative Morbidity Index
Comprehensive Complication Index

Authors

Mateusz Sitkowski
Jakub Kenig

References (52)
  1. 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.
    CrossRefPubMed
  2. Martin RCG, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002; 235(6): 803–813.
    CrossRefPubMed
  3. Brennan MF. Postoperative complication reporting: more than mortality and morbidity. Ann Surg. 2013; 258(1): 8–9.
    CrossRefPubMed
  4. Kenig J. Oncogeriatrics (part 2.). Normal and pathological ageing. Nowotwory. Journal of Oncology. 2019; 69(3-4): 146–149.
    CrossRef
  5. 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.
    CrossRefPubMed
  6. Kenig J. Oncogeriatrics (part 4.) Pre-operative assessment of elderly patients with cancer. Nowotwory. Journal of Oncology. 2020; 70(1): 16–19.
    CrossRef
  7. 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.
    CrossRef
  8. 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.
    CrossRefPubMed
  9. Kenig J. Oncogeriatrics (part 1.). Frailty in older adults with cancer. Nowotwory. Journal of Oncology. 2019; 69(2): 55–57.
    CrossRef
  10. Kenig J. Oncogeriatrics (part 3.) Influence of surgical trauma on older patients. Nowotwory. Journal of Oncology. 2019; 69(5-6): 163–167.
    CrossRef
  11. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111(5): 518–526.
    PubMed
  12. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009; 250(2): 177–186.
    CrossRefPubMed
  13. 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.
    CrossRefPubMed
  14. 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.
    CrossRefPubMed
  15. 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.
    CrossRefPubMed
  16. 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.
    CrossRefPubMed
  17. 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.
    CrossRefPubMed
  18. 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.
    CrossRefPubMed
  19. 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.
    CrossRefPubMed
  20. 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.
    CrossRefPubMed
  21. Strasberg S, Hall B. Postoperative Morbidity Index: A Quantitative Measure of Severity of Postoperative Complications. J Am Coll Surg. 2011; 213(5): 616–626.
    CrossRef
  22. 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.
    CrossRefPubMed
  23. 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.
    CrossRefPubMed
  24. Lee MK, Lewis RS, Strasberg SM, et al. Defining the post-operative morbidity index for distal pancreatectomy. HPB (Oxford). 2014; 16(10): 915–923.
    CrossRefPubMed
  25. 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.
    CrossRefPubMed
  26. American College of Surgeons NSQIP Data User Guide 2015.
  27. 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.
    CrossRefPubMed
  28. 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.
    CrossRefPubMed
  29. 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.
    CrossRefPubMed
  30. Boney O, Moonesinghe R, Grocott M. Reply to Slankamenac et al's Comprehensive Complication Index Validation Study. Ann Surg. 2016; 264(2): e11.
    CrossRefPubMed
  31. 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.
    CrossRefPubMed
  32. 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.
    CrossRefPubMed
  33. 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.
    CrossRefPubMed
  34. 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.
    CrossRefPubMed
  35. 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.
    CrossRef
  36. Kenig J, Szabat K. Oncogeriatrics (part 7.). Geriatric assessment for older patients with cancer. Nowotwory. Journal of Oncology. 2020; 70(4): 153–157.
    CrossRef
  37. Story DA. Postoperative complications in elderly patients and their significance for long-term prognosis. Curr Opin Anaesthesiol. 2008; 21(3): 375–379.
    CrossRefPubMed
  38. Sieber FE, Barnett SR. Preventing postoperative complications in the elderly. Anesthesiol Clin. 2011; 29(1): 83–97.
    CrossRefPubMed
  39. 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.
    CrossRefPubMed
  40. 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.
    CrossRefPubMed
  41. 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.
    CrossRefPubMed
  42. 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.
    CrossRefPubMed
  43. 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.
    CrossRefPubMed
  44. 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.
    CrossRefPubMed
  45. 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.
    CrossRefPubMed
  46. Kenig J. Oncogeriatrics (part 8.). Frailty screening tools. Nowotwory. Journal of Oncology. 2020; 70(5): 184–186.
    CrossRef
  47. 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.
    CrossRef
  48. 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.
    CrossRefPubMed
  49. 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.
    CrossRefPubMed
  50. 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.
    CrossRefPubMed
  51. 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.
    CrossRefPubMed
  52. 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.
    CrossRefPubMed

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