Key result
Only ~17% of urological surgery studies reporting complications utilize standardized intraoperative adverse event classification systems.
Why the study?
This study was conducted to examine the application of classification systems used to report intraoperative adverse events in urological surgery and to evaluate their crude incidence and type.
Systematic Review (n=15,298)
This systematic review demonstrates that standardized classification systems for intraoperative adverse events are scarcely utilized in urological surgery (16.6% of studies reporting events) and frequently misclassified using postoperative grading scales like Clavien-Dindo.
Answers are grounded in this paper and cite their sources.
Underuse of standardized classification systems limits reliable comparison of urological intraoperative complications; challenges research synthesis and supports mandatory adoption in future studies.
Purpose To perform a systematic review (SR) to examine the application of classification systems (CS) used to report intraoperative adverse events (iAEs) in urological surgery and to evaluate the crude incidence and type of iAEs. Materials and Methods This review was published via PROSPERO (CRD42024549954) and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). MEDLINE, Embase, and the Cochrane CENTRAL were searched using a predefined PICO framework: (P) patients with benign and malignant urological diseases, (I) all types of urological surgery, (C) none/any, (O) intraoperative complications classified with grading systems. Retrospective and prospective studies published between January 2019 and June 2024 were included. Results The search yielded 1,570 abstracts, 1,043 full-text articles were assessed for eligibility, of which 325 studies reported iAEs (54 used iAE-CS, 64 used Clavien-Dindo Classification and 207 used free-text descriptions). Of the 54 studies (15,298 patients) that used an iAE-CS, the three most used systems were the EAUiaiC (54%), SATAVA (26%), and the modified SATAVA (7%). The overall incidence of iAE was 14% (2,153/15,225 patients). On a study level, the crude incidence of iAE was between 0%-100% (median 7%, IQR: 3%-13%). The misapplication of the Clavien-Dindo system to describe iAEs was high (n = 64 studies). Conclusions The use of iAE-CS is scarce, and there is a lack of universal consensus on a CS to describe iAEs. iAE are poorly reported in urological studies. Urologists should report all perioperative complications to improve transparency and surgical and hospital processes.
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Ortner et al. (2025) conducted a systematic review in Benign and malignant urological diseases requiring surgery (n=15,298). Urological surgery was evaluated on Proportion of urological surgery studies reporting intraoperative adverse events that utilized a dedicated intraoperative adverse event classification system. Intraoperative adverse event classification systems were utilized in 16.6% (54/325) of urological surgery studies reporting intraoperative complications, with an overall incidence of 14%.
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