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Measuring and achieving the best possible outcomes in surgery. BJS 2017; 104: 1121-1122.

Published: 10th May 2017

Authors: P.‐A. Clavien, M. A. Puhan

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Henrik Kehlet

4 weeks ago

Measuring and achieving better surgical outcomes?

In their editorial (1) Clavien and Puhan summarise the elegant improvements within standardising descriptors for the measurement of postoperative complications and finalised into the Comprehensive Complication Index (CCI). These developments serve as a rational basis for monitoring outcomes and to be used in benchmarking studies.

However, when it comes to “achieving” better outcomes their article might have benefitted from an additional discussion on further improvements when using the CCI. Thus, as suggested before, a time-course analysis of the complications would be beneficial because an initial early direct “surgical” complication (wound dehiscence, major bleeding, anastomotic leakage, etc.) may lead to a higher risk of “medical” complications (pulmonary, cardiac, thromboembolic, etc.). However, oppositely an initial “medical” complication may lead to a higher risk of a “surgical” complication.(2) Consequently, the time-course analysis of complications may improve our understanding on the pathophysiology of the postoperative morbidity and where an initial “surgical” complication needs attention to “surgical” expertise, while an initial “medical“ complication demands a focus on the all-over care setup within the “concept of fast-track surgery” or “enhanced recovery programs” which have been documented to decrease the risk of medical complications.(2)

Hopefully, the major improvements developed by Clavien and co-workers to assess surgical complications in more detail will assist to “achieve” better outcomes combined with the above considerations.

Henrik Kehlet
Section of Surgical Pathophysiology 7621
Rigshospitalet, Blegdamsvej 9
DK-2100 Copenhagen

1. Clavien PA, Puhan MA. Measuring and achieving the best possible outcomes in surgery. Br J Surg 2017; 104: 1121-1122.
2. Kehlet H, Jorgensen CC. Advancing surgical outcomes research and quality improvement within an enhanced recovery program framework. Ann Surg 2016; 264: 237-238.