Discussing Complications after Surgery Consists of Multiple Dimensions

Surgeons are obligated to assure the highest quality of care for their patients, and part of this process is regular in-house audits to review their results and outcomes.[1] [2] Complications must be reported, documented, and discussed, to collectively learn from adverse events and to prevent them in the future.[3] [4] Multiple recent analyses provide information on the beneficial aspects of systematic prospective assessment of adverse events in the surgical management of patients to obtain the real incidence and extent of complications.[5] [6] [7] This strategy is the keystone to prepare for (serious) adverse events for the morbidity and mortality conferences, which, if necessary, result in amendments of the standard operating procedures (SOP) based on the discussions. While numerous projects focus on the patients' outcome after (serious) adverse events, the surgeon's perspective and their coping with those events is still neglected in the literature.[8]

Furthermore, in the time of global scientific exchange, surgeons are interested in comparing their results with international expert centers. Therefore, uniform reporting of adverse events in the in- and out-patient care of surgical patients was aimed at early and finally resulted in the multidisciplinary OUTCOME4MEDICINE consensus conference in Zurich in 2022.[9] In an extraordinary approach of inviting various stakeholders, from clinicians, insurance to patients' representatives, benchmarks for reporting the outcome of general surgery were defined. The results of the conference are now made available to all as an article in the esteemed Journal of Nature Medicine.

While the meeting was the climax of a decade-long development[10] [11] [12] in general surgery, starting with the definition of complications and the implementation of severity grading systems, those milestones have so far been ignored in pediatric surgical literature.

The purpose of this review block, in a joint approach of pediatric and general surgical working groups, is to give a broad readership of pediatric surgeons an overview on current developments in the processing and discussion of complications in surgical patients, highlighting drawbacks in the pediatric surgical literature and providing the readership with guidelines for their clinical and academic routine.

de Vos et al[13] present practical guidelines for the organization and process of morbidity and mortality conferences that should be implemented into clinical practice.

Kalt et al[14] provide the readers with an overview of classifications of adverse events in the intra- and postoperative management of adult surgical patients, giving additional insight into the digitalization of documentation.

Madadi-Sanjani et al[15] give an overview on current scientific practices of the assessment and classification of adverse events in the pediatric surgical literature, concluding practical guidelines for future application.

Himidan et al present the psychological aspects of dealing with a complication from a surgeon's perspective.

We appreciate this issue of the European Journal of Pediatric Surgery and hope that it will contribute to promoting the topic among pediatric surgeons all over the globe.

Publication History

Article published online:
17 March 2023

• References

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• 13 de Vos MS, Verhagen MJ, Hamming JF. The morbidity and mortality conference: a century-old practice with ongoing potential for future improvement. Eur J Pediatr Surg 2023 (e-pub ahead of print). DOI: 10.1055/s-0043-1760836.
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