Skip to main content

Advertisement

Log in

Development and Assessment of Memorial Sloan Kettering Cancer Center’s Surgical Secondary Events Grading System

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Studying surgical secondary events is an evolving effort with no current established system for database design, standard reporting, or definitions. Using the Clavien–Dindo classification as a guide, in 2001 we developed a Surgical Secondary Events database based on grade of event and required intervention to begin prospectively recording and analyzing all surgical secondary events (SSE).

Methods

Events are prospectively entered into the database by attending surgeons, house staff, and research staff. In 2008 we performed a blinded external audit of 1,498 operations that were randomly selected to examine the quality and reliability of the data.

Results

Of 4,284 operations, 1,498 were audited during the third quarter of 2008. Of these operations, 79 % (N = 1,180) did not have a secondary event while 21 % (N = 318) had an identified event; 91 % of operations (1,365) were correctly entered into the SSE database. Also 97 % (129 of 133) of missed secondary events were grades I and II. There were 3 grade III (2 %) and 1 grade IV (1 %) secondary event that were missed. There were no missed grade 5 secondary events.

Conclusions

Grade III–IV events are more accurately collected than grade I–II events. Robust and accurate secondary events data can be collected by clinicians and research staff, and these data can safely be used for quality improvement projects and research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Martin RCG, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002;235:803–12.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystecomy. Surgery. 1992;111:518–26.

    CAS  PubMed  Google Scholar 

  3. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009;250:177–86.

    Article  PubMed  Google Scholar 

  5. Pomposelli JJ, Gupta SK, Zacharoulis DC, Landa R, Miller A, Nanda R. Surgical complication outcome (SCOUT) score: a new method to evaluate quality of care in vascular surgery. J Vasc Surg. 1997;25:1007–14; discussion 1014–5.

    Article  CAS  PubMed  Google Scholar 

  6. Veen MR, Lardenoye JW, Kastelein GW, Breslau PJ. Recording and classification of complications in a surgical practice. Eur J Surg. 1999;165:421–4; discussion 425.

    Article  CAS  PubMed  Google Scholar 

  7. Pillai SB, van Rij AM, Williams S, Thomson IA, Putterill MJ, Greig S. Complexity- and risk-adjusted model for measuring surgical outcome. Br J Surg. 1999;86:1567–72.

    Article  CAS  PubMed  Google Scholar 

  8. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  9. Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228:491–507.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Khuri SF, Henderson WG, Daley J, Jonasson O, Jones RS, Campbell DA Jr, et al. Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery study. Ann Surg. 2008;248:329–36.

    Article  PubMed  Google Scholar 

  11. Lawson EH, Louie R, Zingmond DS, Brook RH, Hall BL, Han L, et al. A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg. 2012;256:973–81.

    Article  PubMed  Google Scholar 

  12. Steinberg SM, Popa MR, Michalek JA, Bethel MJ, Ellison EC. Comparison of risk adjustment methodologies in surgical quality improvement. Surgery. 2008;144:662–7; discussion 662–7.

    Article  PubMed  Google Scholar 

  13. Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250:363–76.

    PubMed  Google Scholar 

  14. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217:833–42; e831–3.

    Google Scholar 

  15. Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204:356–64.

    Article  PubMed  Google Scholar 

  16. Smith JD, Butte JM, Weiser MR, D’Angelica MI, Paty PB, Temple LK, et al. Anastomotic leak following low anterior resection in stage IV rectal cancer is associated with poor survival. Ann Surg Oncol. 2013;20:2641–6.

    Article  PubMed  Google Scholar 

  17. Kelly KJ, Allen PJ, Brennan MF, Gollub MJ, Coit DG, Strong VE. Internal hernia after gastrectomy for cancer with Roux-Y reconstruction. Surgery. 2013;154:305–11.

    Article  PubMed  Google Scholar 

  18. LaFemina J, Vinuela EF, Schattner MA, Gerdes H, Strong VE. Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol. 2013;20:2975–83.

    Article  CAS  PubMed  Google Scholar 

  19. Allen PJ, Chou J, Janakos M, Strong VE, Coit DG, Brennan MF. Prospective evaluation of laparoscopic celiac plexus block in patients with unresectable pancreatic adenocarcinoma. Ann Surg Oncol. 2011;18:636–41.

    Article  PubMed  Google Scholar 

  20. Butte JM, Brennan MF, Gonen M, Tang LH, D’Angelica MI, Fong Y, et al. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J Gastrointest Surg. 2011;15:350–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vivian E. Strong MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Strong, V.E., Selby, L.V., Sovel, M. et al. Development and Assessment of Memorial Sloan Kettering Cancer Center’s Surgical Secondary Events Grading System. Ann Surg Oncol 22, 1061–1067 (2015). https://doi.org/10.1245/s10434-014-4141-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-4141-4

Keywords

Navigation