Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2682
Peer-review started: December 27, 2019
First decision: March 27, 2020
Revised: March 27, 2020
Accepted: May 20, 2020
Article in press: May 20, 2020
Published online: June 7, 2020
Postoperative complications (PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients’ clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC, improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.
Core tip: No surgery service in the world registers and/or audits the postoperative complications (PC) of all the surgical procedures it performs. Most economic studies of PC are of poor quality; without an accurate registration of PC, their costs cannot be reliably determined. The article describes ways of quantifying and classifying PC, discusses the perspectives from which their economic evaluation and monitoring can be approached, and makes recommendations. An accurate assessment of PC and their costs will allow us to determine which areas need investment in order to lower the incidence of PC, improve surgical results, and reduce economic costs.