Article Text

Registration of surgical adverse outcomes: a reliability study in a university hospital
  1. Dirk T Ubbink1,2,
  2. Annelies Visser1,
  3. Dirk J Gouma1,
  4. J Carel Goslings1
  1. 1Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Dirk T Ubbink; d.ubbink{at}


Objective Accurate registration of adverse surgical outcomes is essential to detect areas for improvement of surgical care quality. One reason for inaccurate adverse outcome registration may be the method to collect these outcomes. The authors compared the completeness of the national complication registry database (LHCR) as used in our hospital with relevant information from other available resources.

Design Retrospective reliability analysis.

Setting University hospital.

Participants From the 3252 patients admitted to the surgical wards in 2010, the authors randomly selected a cohort of 180 cases, oversampling those with adverse outcomes. The LHCR contains adverse outcomes as reported during morning hand-offs or in discharge letters. The authors checked if the number and severity of adverse outcomes recorded in the LHCR agreed with those reported in morning hand-offs, discharge letters and medical and nursing files.

Results In 135 of 180 patients, all resources could be retrieved completely. Fourteen per cent of the patients with adverse outcomes were not recorded in the LHCR. Missing adverse outcomes were all reversible without the need for (re)operation, for example, postoperative pain, delirium or urinary tract complications. Only 38% of these adverse outcomes were reported in the morning hand-offs and discharge letters but were best reported in the medical and nursing files.

Conclusions Registration of surgical adverse outcomes appears largely depending on the reliability of the underlying sources. For a more complete adverse outcome registration, the authors advocate a better hand-off and additional consultation of the patient's dossier. This extra effort allows for improvement actions to eventually avoid ‘mild’ adverse outcomes patients perceive as important and undesirable.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Ubbink DT, Visser A, Gouma DJ, et al. Registration of surgical adverse outcomes: a reliability study in a university hospital. BMJ Open 2012;2:e000891. doi:10.1136/bmjopen-2012-000891

  • Contributors All authors have made substantial contributions to the manuscript and have had the opportunity to read and comment upon the present revised manuscript.

  • Funding No specific grant was received from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.