A NEW SYSTEM FOR DEFINING ENDOSCOPIC COMPLICATIONS EMPHASIZING THE MEASURE OF IMPORTANCE

Background: Currently, there are no satisfactory systems for defining, classifying, and/or scoring endoscopic complications, although it wou ld be important for quality assurance, comparative studies, and outcom es research. Recently the term ''negative outcomes'' was proposed rath er than ''complications,'' and an approach that incorporates ''measure s of importance'' was added to compare negative outcomes. Methods: A s ystem was developed that defines, classifies, and grades negative outc omes with a scoring system based on measures of importance. Informatio n was recorded on a Morbidity and Mortality (M & M) form, which was us ed at a monthly quality assurance (M & M) conference. Several measures of importance related to the immediate negative outcome (O) were quan tified (effect of the complication on completion of the endoscopy, cha nge in level of care, change in number of hospital days, necessity for new invasive procedures). The disability (D), defined as a residual o r chronic negative outcome caused by the complication, was characteriz ed and scored. Death (D) was also characterized, the value varying wit h circumstances. As a quantitative measure, an overall ODD score was u sed. Results: One hundred twenty-three negative outcomes were retrospe ctively classified using the new M & M form and the ODD score was appl ied for 117 complications. Complications were ranked according to the ODD score. Conclusion: A system for defining, classifying, and grading negative outcomes of endoscopic procedures is proposed with a quantit ative scoring system that emphasizes measures of importance. The ODD s core looks at the immediate negative outcome and also the separate lon g-term issues of disability and death.