Complication vs adverse event
Adverse event = unintentional harm, arising from an episode of healthcare, not due to the disease process itself
e.g. post-op leak, intra-op injury, post-op pneumonia, DVT
An adverse event is differentiated from complication in that “unintentional harm” constitutes an adverse event
Some complications are unavoidable aspects of treatment – eg. Failed TOV post TURP ; not actual harm from treatment, but recognised post-operative outcome at a certain rate
Whereas an adverse event would be a re-presentation with clot retention or incontinence post-TURP, where unintentional harm arose as a result of the procedure
All major adverse events should be discussed in a peer review meeting, but many minor ones like post-op UTI don’t need to be discussed
Clavien-Dindo classification scale
CD 1
Any deviation from expected post-op course without needing pharmacological treatment or intervention (did not prolong admission ; little impact on patients wellbeing)
Eg. Untreated fever ; catheter bypassing ; ED presentation for haematuria
CD2
Requiring pharmacological treatment, including blood transfusion or TPN
Eg. Infection requiring antibiotics, bleeding requiring transfusion
CD3
Complication requiring intervention – surgery, radiological, endoscopic
3a – No GA
3b – GA required
Eg. 3a – post PCNL bleed requiring embolization, post URS crumb for neph
3b – clot retention requiring washout under GA; post URS crumb for stent
CD4
Life threatening complication needing ICU
4a – Single organ dysfunction including dialysis
4b – Multiorgan dysfunction
Eg. 4a – post op renal failure needing RRT; post op sepsis needing inotropes
4b – post op sepsis requiring inotropes; intubation; dialysis
CD5
Death