Complications in Surgery – Let’s Face Them

Accessible online at: www.karger.com/journals/dsu Patients admitted to a surgical ward have a chance of more than 10% to encounter a severe adverse effect of their treatment [1]. For some types of gastrointestinal surgery the risk of complication can be as high as 50%. Some of these complications, as superficial wound infection after surgery for perforated viscera, are rather frequent but will only minimally effect the immediate outcome of treatment, although incisional hernias may result. Other complications, such as iatrogenic bile duct injury after laparoscopic cholecystectomy, are infrequent but have a dramatic effect on the outcome of the treatment. Iatrogenic bile duct injury can lead to reinterventions, that vary from endoscopic papillotomy to liver transplantation and can lead to severe impairment of the patient’s quality of life, even after successful interventions or repair [2]. Anastomic leakage after resection and reconstruction of the various parts of the digestive tract and intraabdominal parenchymatous organs is one of the most feared complications, that in the worst-case scenario can lead to generalized peritonitis septicemia and death. In many cases, reinterventions are needed. That means repeated relaparotomies, that can be planned or based on a patient’s clinical situation (on demand), with drainage of the anastomosis or diverting enterostomies. Salvage pancreatectomy is in some cases the only remedy to have a patient survive after a leaking pancreaticojejunostomy, leading to a brittle diabetes with its own serious complications [3]. Whereas the success of surgery is frequently measured by cure rate and (long-term) survival, postoperative morbidity (i.e. complication rate) and mortality should be more prominently used in evaluations of surgery. Therefore the management of postoperative complications should be a very important activity in all surgical departments. Surgeons should also be aware of the incidence of complications of various therapies by collecting and analyzing their own data. At the department of surgery of the Academic Medical Center in Amsterdam, complications are being registered with great care. The department is both serving the community and functions as a secondary and tertiary referral center for gastrointestinal surgery. The complications of all patients discharged from the surgical wards are scored in a daily plenary session with all staff present including the trainees, in order to enhance the completeness of the registration, although underscoring of events will take place, like in all systems. Around 3,100 patients are discharged each year, of whom around 70% underwent an operation. Of all patients, 11.2% had a complication in the year 2000. This percentage has not changed very much over the years. The presence of a complication has a striking effect on the mean hospital stay, that is about three times longer in patients with complications than without (table 1). Complications are especially frequent in patients treated in the year 2000 for malignant disease (22.5%) as compared with benign disease (8.8%). Patients with gastroesophageal disease have a higher complication rate