64 - Freie Mitteilung
16. Mai 2019, 13:45 - 15:15, Szenario 1, 5. OG
International multicentre cohort study for the external validation of CLASSIC – Classification of Intraoperative Complications
P. Kirchhoff1, N. V. Gomes1, L. Gawria1, 2, L. Villarino3, M. I. Rochera3, A. Solis3, R. Martin3, C. Blanc4, O. Gié4, D. Hahnloser4, H. Van Goor2, R. ten Broek2, C. Rosman2, P. Schuhmacher5, C. Brandt5, R. Schmid5, S. Joller1, B. Goebel1, J. Mayr1, S. Meier6, S. J. Kang6, M. Aduse-Poku6, P. Delrio7, D. Rega7, U. Pace7, B. Loveday8, I. Bissett8, G. O'Grady8, F. Herbst9, S. Ghaffari9, A. Engel10, J. Murugesan10, M. Ozcelik11, I. E. Gecim11, O. Ioannidis12, K. Galanos12, D. Vrochides13, M. Passeri13, P. F. Ridgway14, C. Clancy14, D. M. Nally14, H. R. Bruppacher15, B. Ranter16, S. Rabanser17, L. A. Steiner1, P. A. Clavien15, R. Rosenthal1, S. Dell-Kuster1, Presenter: N. V. Gomes1 (1Basel, 2Nijmegen/NL, 3Barcelona/ES, 4Lausanne, 5Solothurn, 6London/UK, 7Naples/IT, 8Auckland/NZ, 9Wien/AT, 10Sydney/AUS, 11Ankara/TR, 12Thessaloniki/GR, 13Charlotte/USA, 14Dublin/IE, 15Zurich, 16Innsbruck/AT, 17Chur)
This international prospective cohort study aimed to assess the external validity and practicability of CLASSIC, a newly developed CLASSification of Intraoperative Complications (CLASSIC). The updated CLASSIC defines 5 severity grades depending on the need for treatment and severity of symptoms.
In 18 centres from 12 countries, patients undergoing any type of surgery were consecutively enrolled, excluding one-day surgeries (NCT03009929). The attending surgical and anaesthesia team graded all intraoperative complications according to CLASSIC. All postoperative complications were assessed daily until hospital discharge and graded using the Clavien-Dindo classification. The association between the most severe intra- and postoperative complication (primary endpoint) was investigated using Spearman’s rho. The association between the most severe intraoperative complication and the postoperative length of stay (pLOS; secondary endpoint) was investigated in a multivariable median regression model with robust standard errors considering study centre clustering. This analysis was adjusted for age, ASA-class, wound classification, complexity and urgency of the procedure. In a survey including 10 fictitious case scenarios describing intraoperative complications, reliability of CLASSIC was assessed using the intra-class correlation coefficient (ICC).
Out of 2640 patients screened, 2520 patients were enrolled, of which 610 (24%) experienced any intraoperative complication. 2508 postoperative complications were observed in 838 patients (33%). In-hospital mortality was 1% (n=25). The Spearman correlation between the most severe intra- and postoperative complication was 0.22 (p˂0.001). In multivariable analysis, median pLOS increased with each CLASSIC grade (from 0.5 days (95% CI -0.03, 1.03) for Grade I vs 0, up to 4.5 days (95% CI 0.50, 8.50) for Grade IV vs 0). The survey (response rate 80%) showed an ICC of 0.75 (95% CI 0.59, 0.91). Practicability of CLASSIC was rated as 6 (IQR 5-7) out of 9.
CLASSIC provides a validated and standardised tool to quantify and qualify intraoperative complications in clinical practice and research with a high reliability and practicability. Intraoperative complications show an association with important postoperative outcomes, rendering CLASSIC a useful tool to enhance perioperative patient safety.