New Complication Classification

Proposed New Complication Classification (primarily surgical, but could possibly also be used for complications of medical care).

1. Alteration from ideal postoperative course that is not life-threatening and does not lengthen postoperative stay

  • a. Complication requiring only analgesics, antipyretics, antiemetics, antidiarrheals, drugs for urinary retention or drugs for lower urinary tract infection
  • b. Complication requiring urinary catheterization but not prolonging hospital stay
  • c. Complication requiring NG decompression but not prolonging hospital stay or complication requiring bedside drainage and/or debridement of wound infection, but not prolonging hospital stay

2. Alteration from ideal postoperative course that is potentially life-threatening or lengthens postoperative stay or causes readmission but does not cause residual disability or organ resection

  • a. Urinary retention requiring urinary catheterization and prolonging hospital stay or causing readmission or wound infection prolonging hospitalization or requiring readmission for wound care
  • b. Complication lengthening hospital stay or causing readmission but not causing permanent disability and not requiring reoperation, complex imaging studies or endoscopy, for example, prolonged postoperative ileus, reversible acute renal failure, reversible acute respiratory insufficiency, reversible acute heart failure, anemia requiring transfusion, bleeding not severe enough to require reoperation these complications require simple X-ray studies (CXR and abdominal X-rays), NG decompression, blood/blood components, hospital TPN, IV antibiotics (except IV antibiotics for lower urinary tract infections), cardiac drugs (that the patient was not taking before admission) or treatment for reversible acute renal failure
  • c. Reversible complications requiring mechanical ventilation or complications requiring complex imaging procedures, such as fluoroscopic procedures (GI imaging studies), IVP’s, fistulograms, CT scans, MRI scans, sonograms looking for bile duct obstruction or abdominal abscess
  • d. Complications requiring endoscopy or interventional radiology (nephrostomy tube placement, percutaneous drainage of abscess) or chest tube placement
  • e. Complications requiring reoperation but not causing permanent disability or organ loss (for example, reoperation for bleeding, bowel obstruction, anastomotic leak or intra-abdominal abscess)

3. Complication causing (or potentially causing) permanent disability or resulting in organ loss, for example, nerve injury, common bile duct injury, ureteral injury, spleen injury resulting in splenectomy, kidney injury resulting in nephrectomy, post-op gangrene resulting in amputation, Volkman’s ischemic injury to forearm muscles due to tight forearm cast; irreversible renal failure requiring dialysis,, irreversible acute respiratory insufficiency requiring lifelong mechanical ventilation, brain injury, stroke, MI, short bowel syndrome or non-healing fistula requiring home hyperalimentation

4. Death

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