Abstract
Successful surgery combines quality (achievement of a positive outcome) with safety
(avoidance of a negative outcome). Outcome assessment serves the purpose of quality
improvement in health care by establishing performance indicators and allowing the
identification of performance gaps. Novel surgical quality metric tools (benchmark
cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes
in a subgroup of well-defined low-risk patients, with the aim of setting realistic
and best achievable goals for surgeons and centers, as well as supporting unbiased
comparison of surgical quality between centers and periods of time. Validated classification
systems have been deployed to grade adverse events during the surgical journey: (1)
the ClassIntra classification for the intraoperative period; (2) the Clavien–Dindo
classification for the gravity of single adverse events; and the (3) Comprehensive
Complication Index (CCI) for the sum of adverse events over a defined postoperative
period. The failure to rescue rate refers to the death of a patient following one
or more potentially treatable postoperative adverse event(s) and is a reliable proxy
of the institutional safety culture and infrastructure. Complication assessment is
undergoing digital transformation to decrease resource-intensity and provide surgeons
with real-time pre- or intraoperative decision support. Standardized reporting of
complications informs patients on their chances to realize favorable postoperative
outcomes and assists surgical centers in the prioritization of quality improvement
initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the
enhancement of clinical standards.
Keywords
surgical outcomes - complications - classification - benchmarks - textbook outcomes
