Recording and Classification of Complications in a Surgical Practice

OBJECTIVE: To document the incidence and outcome of complications in the department of surgery. DESIGN: Retrospective study. SETTING: District hospital, The Netherlands. SUBJECTS: 7455 patients operated on between 1 January 1993 and 31 December 1995. MAIN OUTCOME MEASURES: Documentation and outcome of complications (defined as "every unwanted development in the illness of the patient or in the treatment of the patient's illness that occurs in the clinic"). RESULTS: 1078 complications were recorded after 8130 operations (13%), 337 (33%) of which had no long term effects. 175/1078 (16%) required reoperation, and in 134 of these (77%) an error in management or surgical technique was responsible for the complication. 6 patients were irreversibly harmed and of the 141 patients who died, 11 had evidence of some sort of error. CONCLUSIONS: Audit of complications is necessary to improve practice in a surgical department, and weekly morbidity and mortality meetings are a good opportunity for learning about them.