부산대학교 도서관

Background: Grading scales for adverse surgical outcomes have been poorly characterized to date. The primary aim of this study was to conduct a systematic review to enumerate the various frameworks for grading adverse postoperative outcomes; our secondary objective was to outline the properties of each grading system, identifying its strengths and weaknesses. Methods: We searched 9 databases (Africa Wide Information, Biosis, Cochrane, Embase, Global Health, LILACs, Medline, PubMed and Web of Science) from 1992 (the year the Clavien-Dindo classification system was developed) until Mar. 2, 2017, for studies that aimed to develop or improve on an already existing generalizable system for grading adverse postoperative outcomes. Study selection was duplicated as per PRISMA recommendations. Procedure-specific grading systems were excluded. We assessed the framework, strengths and weaknesses of the systems qualitatively. Results: We identified 9 studies on 8 adverse outcome grading systems with frameworks generalizable to any surgical procedure. Most systems have not been widely incorporated in the literature. Seven of the 8 systems were produced without including patients' perspectives. Four allowed the derivation of a composite morbidity score, which had limited tangible significance for patients. Conclusion: Although each instrument identified offered its own advantages, none satisfied the need for a patient-centred tool capable of generating a composite score of all possible postoperative adverse outcomes (complications, sequelae and failure) that enables comparison of noninterventional and surgical management of disease. There is a need for development of a more comprehensive, patient-centred grading system for adverse postoperative outcomes. Contexte : Jusqu'ici, les systemes de classification des issues postoperatoires indesirables n'ont pas encore fait l'objet d'une analyse comparative. Cette etude avait pour objectif principal de recenser, au moyen d'une revue systematique de la litterature, les divers systemes de classification des issues postoperatoire indesirables, et pour objectif secondaire de degager les proprietes, les forces et les faiblesses de chaque systeme. Methodes : Nous avons interroge 9 bases de donnees (Africa Wide Information, Biosis Previews, Cochrane, Embase, Global Health, LILACS, Medline, PubMed et Web of Science) pour trouver des articles publies entre 1992 (annee de la mise au point du systeme de classification de Clavien-Dindo) et le 2 mars 2017. Ces articles devaient porter sur la creation d'un systeme generalisable de classification des issues postoperatoires indesirables, ou l'amelioration d'un systeme existant. La selection des etudes a ete faite en double, conformement aux recommandations PRISMA. Les systemes de classification visant une seule intervention ont ete exclus. Nous avons evalue, d'un point de vue qualitatif, le cadre, les forces et les faiblesses des systemes retenus. Resultats : Nous avons retenu 9 etudes sur 8 systemes de classification accompagnes d'un cadre pouvant etre applique a n'importe quelle intervention chirurgicale. La plupart des systemes n'avaient pas ete largement etudies. Sept des 8 systemes avaient ete developpes sans tenir compte du point de vue des patients, et 4 permettaient de calculer un score de morbidite composite ayant des retombees concretes limitees pour les patients. Conclusion : Tous les systemes retenus s'accompagnaient d'avantages, mais aucun ne pouvait servir d'outil centre sur le patient permettant de calculer un score composite pour toutes les issues postoperatoires possibles (complications, sequelles et echec), score qui pourrait servir a comparer les prises en charge conservatrice et chirurgicale des maladies. La creation d'un systeme de classification des issues postoperatoires indesirables exhaustif centre sur le patient est necessaire.
Lack of consensus in defining and measuring the severity of adverse surgical outcomes hinders reliable comparison and categoric assessment of the quality and risks of surgical procedures. (1,2) About 80% [...]