Recording and classification of complications in a surgical practice

Objective: To document the incidence and outcome of complications in the de partment of surgery. Design: Retrospective study. Setting: District hospital, The Netherlands. Subjects: 7455 patients operated on between 1 January 1993 and 31 December 1995. Main outcome measures: Documentation and outcome of complications (defined as "every unwanted development in the illness of the patient or in the trea tment of the patient's illness that occurs in the clinic"). Results: 1078 complications were recorded after 8130 operations (13%), 337 (33%) of which had no long term effects. 175/ 1078 (16%) required reoperati on, and in 134 of these (77%) an error in management or surgical technique was responsible for the complication. 6 patients were irreversibly harmed a nd of the 141 patients who died, 11 had evidence of some sort of error. Conclusions: Audit of complications is necessary to improve practice in a s urgical department, and weekly morbidity and mortality meetings are a good opportunity for learning about them.