What is a Surgical Complication?

Abstract

The concise article by Daniel Sokol and James Wilson from the United Kingdom delivers a pointed analysis of the semantic derivation of a definition of ‘‘surgical complication’’ [1]. They note the discrepancy among definitions of this highly relevant topic, and indeed there is little in the literature that scientifically defines what a surgical complication actually is. Most of the general source material on medical error has not specifically looked at errors on the surgical services at all. The authors’ definition of surgical complication evolves into ‘‘an undesirable unintended problem that is a direct result of the surgery itself, and that would not have occurred had the operation gone as well as could reasonably be expected.’’ This seems to include a relationship of the incident to the operation, that the result is not expected or welcomed, and that there is some flexibility of the definition proportional to the expected outcome—i.e., that the risk factors play a role in the anticipated results. We think that this definition, although perhaps not ideal for all circumstances, does provide a platform from which to study the problem and initiate changes that may improve performance in this regard. There are, however, some important issues that must be included in any discussion of surgical error. If there is, indeed, error determined to have affected outcome, identifying the type of error is important in defining its significance. Thus some questions remain: Was the patient harmed? Was only the length of hospital stay affected? Was there permanent disability? Did the patient die? Specification of the genesis of the error also plays an essential role in using the information surrounding the error to improve future performance. For example, was the error technical? Was it judgmental? Was it an error in diagnosis? Without such qualification, solutions are difficult if not impossible to generate. We wonder whether the best definition should allow for analysis of a ‘‘cascade effect’’ wherein multiple causative components come together to give undesirable results. Also, is there a way to assess for latent errors (often called ‘‘near-miss situations’’) so that they can be considered in the improvement process as well? We are convinced that the definition offered here is a good start to the analysis of surgical error, keeping in mind that errors within the surgical domain are likely not a factor in other areas of medicine. With the caveats expressed above we commend the authors for a concise primer on surgical complications, and we simply wish to emphasize that there are a number of modifiers and additional data points necessary to complete the definition so that it is more relevant to the solutions which are surely needed.