Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification

Abstract

Introduction: The registration of complications represents an important component in the evaluation of surgical therapeutic procedures. The aim of the present study was to examine the frequency of occurrence as well as the severity of surgical complications after laparoscopic-gynaecological operations in a standardised manner using the Clavien-Dindo system.
Material and Methods: Altogether 7438 treatment courses after laparoscopic-gynaecological interventions by 9 working groups were evaluated. Covariates recorded were the technical complexity of the operation, type of study cohort, study size, data acquisition as well as study centre. Target variables recorded were the surgical morbidity rate, subdivided into mild (Clavien-Dindo grade I–II) and severe complications (Clavien-Dindo grade III–V). In addition, a binary logistic regression analysis for the mentioned covariates and the occurrence of surgical complication was carried out.
Results: 946 complications were recorded (overall complication rate: 13 %). These included 664 mild complications (8.9 %) and 305 severe complications (4.1 %). A correlation was found between the covariates technical complexity (relative risk [rR] 1.37; p < 0.01), study size (rR: 0.35; p < 0.01) and study centre (rR 0.19; p < 0.01) and the occurrence of surgical complications.
Conclusion: By means of a standardised registration of complications using the Clavien-Dindo classification it appears to be possible to limit the methodologically caused underestimation of surgical morbidity in the retrospective evaluation of gynaecological-endoscopic therapeutic procedures. Factors decisively influencing the surgical morbidity of gynaecological-laparoscopic therapeutic procedures are the respective operative experience of the treating facility as well as the technical complexity of the intervention.

Zusammenfassung

Einführung: Die Erfassung von Komplikationen stellt einen wichtigen Bestandteil bei der Evaluation operativer Therapieverfahren dar. Ziel der vorliegenden Arbeit war es, die Häufigkeit des Auftretens sowie die Schwere von chirurgischen Komplikationen nach laparoskopisch-gynäkologischen Operationen standardisiert mithilfe des Clavien-Dindo-Systems zu untersuchen.
Material und Methodik: Insgesamt 7438 Behandlungsverläufe nach laparoskopisch-gynäkologischen Eingriffen, erhoben von 9 Arbeitsgruppen, wurden ausgewertet. Als Kovariaten wurden technischer Schwierigkeitsgrad des Eingriffs, Art der Studienkohorte, Studiengröße, Datenakquise sowie Studienzentrum erfasst. Als Zielvariable wurde die chirurgische Morbiditätsrate, unterteilt in leichte (Clavien-Dindo Grad I–II) und schwere Komplikationen (Clavien-Dindo Grad III–V) erhoben. Ferner erfolgte eine binär logistische Regressionsanalyse für die aufgeführten Kovariaten und dem Auftreten von chirurgischen Komplikationen.
Resultate: 946 Komplikationen wurden erfasst (Gesamtkomplikationsrate: 13 %). Hierbei handelte es sich um 664 leichte Komplikationen (8,9 %) und 305 schwere Komplikationen (4,1 %). Es zeigte sich eine Korrelation zwischen den Kovariaten technischer Schwierigkeitsgrad (relatives Risiko [rR] 1,37; p < 0,01), Studiengröße (rR: 0,35; p < 0,01) und Studienzentrum (rR 0,19; p < 0,01) und dem Auftreten chirurgischer Komplikationen.
Schlussfolgerungen: Durch eine standardisierte Komplikationserfassung mithilfe der Clavien-Dindo-Klassifikation erscheint es möglich, die methodisch bedingte Unterschätzung der chirurgischen Morbidität bei der retrospektiven Auswertung von gynäkologisch-endoskopischen Therapieverfahren zu begrenzen. Als die chirurgische Morbidität gynäkologisch-laparoskopischer Therapieverfahren maßgeblich beeinflussende Faktoren wurden die jeweilige operative Erfahrung der durchführenden Behandlungseinrichtung sowie der technische Schwierigkeitsgrad des Eingriffs identifiziert.

Key words

laparoscopy - gynaecological surgery - complications

Schlüsselwörter

Laparoskopie - gynäkologische Chirurgie - Komplikationen

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