Abstract
Severity grading systems for complications in surgical patients have been used since
1992. An increasing assessment of these instruments in pediatric surgery is also noticed,
without their validation in children. To analyze the current practice, we performed
a literature review with focus on the assessment and grading of complications. The
review was performed according to the Preferred Reporting Items for Systematic Reviews
and Meta-analyses (PRISMA) guidelines. Studies reporting on postoperative complications
as a primary or secondary endpoint using a severity grading system were included.
Definition for simple adverse events, classification systems used, and the time horizon
of postoperative documentation were analyzed. A total of 566 articles were screened,
of which 36 met the inclusion criteria. About 86.1% of the papers were retrospective
and 13.9% prospective analyses. None of the studies were prospective-randomized trials.
Twenty (55.6%) studies did not include a definition of adverse events, whereas the
remaining 16 (44.4%) showed variations in their definitions. All studies applied the
Clavien-Dindo classification, whereas five (13.9%) additionally used the Comprehensive
Complication Index. One study compared alternative grading instruments with the Clavien-Dindo
classification, without demonstrating the superiority of any classification in pediatric
surgery. Twenty-two studies (61.1%) did not report the time horizon of perioperative
complication documentation, while 8 studies (22.2%) used 30 days and 6 studies (16.7%)
used 3 months of postoperative documentation. Definition and classification of postoperative
complications are inconsistent in the pediatric surgical literature. Establishment
of a standardized protocol is mandatory to accurately compare outcome data.
Keywords
pediatric surgery - complications - adverse events - classification - Clavien-Dindo
