Table of Contents
ISRN Surgery
Volume 2013, Article ID 625093, 7 pages
Review Article

Morbidity Assessment in Surgery: Refinement Proposal Based on a Concept of Perioperative Adverse Events

1Interventional Centre, Oslo University Hospital-Rikshospitalet, 0027 Oslo, Norway
2Surgical Department, Skien Hospital, Sykehuset Telemark Hospital Trust, 3710 Skien, Norway
3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
4Department of Gastrointestinal Surgery, Oslo University Hospital-Rikshospitalet, 0027 Oslo, Norway

Received 25 March 2013; Accepted 22 April 2013

Academic Editors: C. F. Bianchi, T. L. Hwang, A. Petroianu, and A. Polydorou

Copyright © 2013 Airazat M. Kazaryan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Morbidity is a cornerstone assessing surgical treatment; nevertheless surgeons have not reached extensive consensus on this problem. Methods and Findings. Clavien, Dindo, and Strasberg with coauthors (1992, 2004, 2009, and 2010) made significant efforts to the standardization of surgical morbidity (Clavien-Dindo-Strasberg classification, last revision, the Accordion classification). However, this classification includes only postoperative complications and has two principal shortcomings: disregard of intraoperative events and confusing terminology. Postoperative events have a major impact on patient well-being. However, intraoperative events should also be recorded and reported even if they do not evidently affect the patient’s postoperative well-being. The term surgical complication applied in the Clavien-Dindo-Strasberg classification may be regarded as an incident resulting in a complication caused by technical failure of surgery, in contrast to the so-called medical complications. Therefore, the term surgical complication contributes to misinterpretation of perioperative morbidity. The term perioperative adverse events comprising both intraoperative unfavourable incidents and postoperative complications could be regarded as better alternative. In 2005, Satava suggested a simple grading to evaluate intraoperative surgical errors. Based on that approach, we have elaborated a 3-grade classification of intraoperative incidents so that it can be used to grade intraoperative events of any type of surgery. Refinements have been made to the Accordion classification of postoperative complications. Interpretation. The proposed systematization of perioperative adverse events utilizing the combined application of two appraisal tools, that is, the elaborated classification of intraoperative incidents on the basis of the Satava approach to surgical error evaluation together with the modified Accordion classification of postoperative complication, appears to be an effective tool for comprehensive assessment of surgical outcomes. This concept was validated in regard to various surgical procedures. Broad implementation of this approach will promote the development of surgical science and practice.