Surgeons Are Overlooking Post-Discharge Complications: A Prospective Cohort Study
- 302 Downloads
The registration of surgical complications is an important quality indicator of hospital medical care. Previous research has suggested that surgeons only record certain complications after discharge. The extent and impact of this potential under-recording of post-discharge complications is unknown. Therefore, we aimed to determine the frequency, type, and grade of post-discharge complications as reported by patients and their surgeons.
A prospective cohort study was performed in the Department of Surgery of a University Medical Center. From December 2008 until August 2009, all adult surgical patients were interviewed by phone or questionnaire 1 month after their discharge to inquire about any new complications after discharge. These complications were compared with the surgeon-reported post-discharge complications and letters from the outpatient clinic as documented in the patients’ medical files.
A total of 976 patients were included. Patients reported more complications (659) than did surgeons (465), especially psychological disturbances (4.2 vs. 0 %). A medical consult was needed in 527 (80 %) of the patient-reported complications. Of all patient-reported complications, 291 (44 %) resulted in a visit to the outpatient clinic, 144 (22 %) in a consultation with a general practitioner, and 92 (14 %) led to referral to a hospital; 743 (76 %) were treated non-operatively.
Surgeons are unaware of many of the complications their patients experience after discharge. These post-discharge complications are important to patients and are therefore relevant to be aware of and to act upon whenever necessary.
KeywordsRisk Difference Medical File Complication Type Abnormal Wound Healing Important Quality Indicator
The authors thank Sarah Baalman (research assistant), Marian Meijer (research assistant), and Anne van Wijngaarden (MD) for assisting in data collection and handling of the database.
Unrestricted grant from the AGIS Health Innovation Project.
Conflict of interest
No conflicts of interest reported.
- 3.de Bruijne MC, Zegers M, Hoornhout LH et al (2007) Onbedoelde schade in Nederlandse Ziekenhuizen. EMGI Instituut en NIVEL, Utrecht. ISBN 978-90-6905-845-0Google Scholar
- 4.Cima RR, Lackore KA, Nehring AA et al (2011) How best to measure surgical quality? Comparison of the Agency of Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution. Surgery 150(5):943–949PubMedCrossRefGoogle Scholar
- 8.Kaasschieter EG, van Olden GJ (2007) Complicatieregistratie en fractuurbehandeling. Ned Tijdschr Trauma 6:182–185Google Scholar
- 10.STROBE statement. http://www.strobe-statement.org. Accessed 30 Sep 2013