Page 32 - Ovarian Cancer Surgery - Quality Indicators

5.10 QI 10 - Existence of a structured prospective reporting of postoperative
complications

5.10.1 Description of the QI

TYPE Outcome indicator.

DESCRIPTION Data to be recorded are reoperations, interventional radiology, readmissions, secondary
transfers to intermediate or intensive care units, and deaths.

SPECIFICATIONS Numerator: number of recorded serious postoperative complications or deaths occurred
among patients with advanced ovarian cancer who have undergone cytoreduction.

Denominator: all complications occurred among patients with advanced ovarian cancer
who have undergone cytoreduction.

TARGETS Optimal target: 100% of complications are prospectively recorded.

Minimum required target: selected cases are discussed at morbidity and mortality
conferences.

SCORING RULE 3 if the optimal target is met, 1 if the minimum required target is met.

5.10.2 Rationale
The absence of consensus within the surgical community on the way to report surgical complications has
hampered proper evaluation of the surgeon’s work and possibly progress in the surgical field. The therapy used
to correct a specific complication remains the cornestone to rank a complication. Conclusive assessments of
surgical procedures remained limited by the lack of consensus on how to define complications and to stratify
them by severity. One previous initiative53 published a QI for this topic.

The Clavien-Dindo classification277,278, a proposed morbidity scale based on the therapeutic consequences of
complications, consisted of 5 severity grades and focused on the medical perspectives, with a major emphasis on
the risk and invasiveness of the therapy used to correct a complication:

 Grade I: any deviation from the normal postoperative course without the need for pharmacological treatment
or surgical, endoscopic, and radiological interventions. Allowed therapeutic regimens are as follows: drugs
as antiemetics, antipyretics, analgetics, diuretics, electrolytes, and physiotherapy. This grade also includes
wound infections opened at the bedside;

 Grade II: requiring pharmacological treatment with drugs other than those allowed for grade I
complications. Blood transfusions and total parenteral nutrition are also included;

 Grade III: requiring surgical, endoscopic or radiological intervention:

o Grade IIIa: intervention not under general anesthesia;

o Grade IIIb: intervention under general anesthesia.

 Grade IV: life-threatening complication including central nervous system complications brain hemorrhage,
ischemic stroke, subarrachnoidal bleeding, but excluding transient ischemic attacks requiring intermediate
care/intensive care unit management:

o Grade IVa: single organ dysfunction including dialysis;

 OVARIAN CANCER SURGERY - QUALITY INDICATORS 
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