Table 2

System-specific complication outcome measures

Cardiovascular
 Angina (exacerbation)Increase in chest pain requiring start or increase of medications
 Arterial thrombosis/embolismInclude peripheral arterial thrombosis or embolism (not including stroke) (not including stroke) demonstrated by CT, MRI or angiography
 ArrythmiaAny cardiac arrhythmia demonstrated on an ECG, except sinus tachycardia and sinus arrhythmia
 HypertensionIncrease in systolic blood pressure requiring start or increase of medications
 Myocardial ischaemiaInclude ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina. Diagnosis must have been confirmed following review of the patient by a cardiologist/on-call medical team
 Venous thrombosis, deep vein thrombosis (DVT)Peripheral venous thrombosis demonstrated by ultrasound, CT, MRI or angiography
 Venous thrombosis, otherVenous thrombosis of the abdominal venous systems, including the coeliac, splenic, hepatic and mesenteric veins. Thrombosis should be demonstrated by CT or MRI
Metabolic
 HypoglycaemiaLow blood sugar requiring intervention
 HyperglycaemiaHigh blood sugar requiring increase or start of new medications
 HypokalaemiaLow serum potassium requiring intervention
 HyperkalaemiaHigh serum potassium requiring intervention
 HypomagnesaemiaLow serum magnesium requiring intervention
 HyponatraemiaLow serum sodium requiring intervention. Include syndrome of inappropriate antidiuretic hormone secretion (SIADH)
 HypernatraemiaHigh serum sodium requiring intervention
 HypophosphatemiaLow serum phosphate requiring intervention
Neurological
 Head injuryInclude extradural haemorrhage, subdural haemorrhage, subarachnoid haemorrhage, cerebral contusion demonstrated on CT or MRI
 Stroke/TIA,Include transient ischaemic attack (TIA), ischaemic or haemorrhagic stroke. Diagnosis must have been confirmed following review of the patient by a stroke physician/on call medical team
Renal
 Acute kidney injuryAcutely deranged renal function, with serum creatine increased to at least 1.5 times greater than the most recent preoperative baseline
 Urinary retentionFailure to pass urine, requiring urinary catheterisation
 Urinary tract infection (UTI)The patient has had clinical evidence of urinary tract infection. UTI must be proven by mid-stream/catheter specimen culture
Respiratory
 Acute respiratory distress syndrome (ARDS)Respiratory failure not explained by cardiac failure or fluid overload, with chest radiograph or CT scan demonstrating bilateral opacities not fully explained by effusions, lobar/lung collapse or nodules
 AtelectasisCollapse of part of the lung, confirmed by chest X-ray or CT scan
 HaemothoraxPresence of blood in the pleural space, confirmed by chest X-ray or CT scan
 Pleural effusionPresence of fluid in the pleural space, confirmed by chest X-ray or CT scan
 Pneumonia, aspirationPulmonary inflammation caused by infection, confirmed by chest X-ray or CT scan. Include pneumonias thought to be caused by aspiration of feed or fluid in to the lungs
 Pneumonia, hospital acquiredPulmonary inflammation caused by infection, confirmed by chest X-ray or CT scan. Include all pneumonias other than aspiration pneumonias
 PneumothoraxPresence of gas in the pleural space, confirmed by chest X-ray or CT scan
 Pulmonary embolusInclude pulmonary emboli (PE) confirmed by CT pulmonary angiogram (CTPA) or ventilation/perfusion (V/Q) scans
 Pulmonary oedemaFluid accumulation in the lung parenchyma, confirmed by chest X-ray or CT scan
Surgical
 AbscessCollection of fluid containing pus. Include any intra-abdominal or intrapelvic abscess, detected clinically, by ultrasound or CT scan and/or intraoperatively
 Anastomotic leakInclude all anastomotic leaks. Include leaks detected by CT scan and/or intraoperatively; and leaks managed conservatively or surgically
 Bile duct injuryIntraoperative injury to the bile ducts requiring further postoperative management
 Bile leakInclude all bile leaks. Include leaks detected by CT scan and/or intraoperatively; and leaks managed conservatively or surgically
 Bladder injuryIntraoperative injury to the bladder requiring further postoperative management
 ChylothoraxPresence of lymphatic fluid in the pleural space, confirmed by chest X-ray or CT scan
 Clostridium difficileC. difficile infection must be confirmed by detection of C. difficile toxin in faeces
 EnterotomyAccidental surgical incision in to the bowel. Include leaks from enterotomies detected by CT scan and/or intraoperatively; and leaks managed conservatively or surgically
 HaematomaCollection of fluid-containing blood, diagnosed clinically or by ultrasound or CT scan
 Haemorrhage, reactionaryHaemorrhage from operative sites within 48 h of operation
 Haemorrhage, secondaryHaemorrhage from operative sites after 48 h of operation
 IleusDelay to return to normal gut function, defined as intolerance to solid food and/or failure to pass flatus >3 days following operation
 Ischaemic colitisInflammation of the colon caused by inadequate blood supply, diagnosed clinically, by CT scan and/or intraoperatively
 Postoperative nauseaPostoperative nausea requiring intervention
 SeromaCollection of serous fluid, diagnosed clinically or by ultrasound or CT scan
 Splenic injuryIntraoperative injury to the spleen requiring further postoperative management
 Upper gastrointestinal (upper GI) bleedInclude upper GI bleed of any aetiology other than haemorrhage from operative sites (select ‘haemorrhage, reactionary/secondary’ for these)
 Ureteric injuryIntraoperative injury to the ureters requiring further postoperative management
 Wound dehiscenceRupture of a surgical wound along the suture line
 Wound infectionWe advise adherence to the Centre for Disease Control's definition of surgical site infection, which is any one of:
  • Purulent drainage from the incision

  • At least two of: pain or tenderness; localised swelling; redness; heat; fever; AND The incision is opened deliberately to manage infection or the clinician diagnoses a surgical site infection

  • Wound organisms AND pus cells from aspirate/swab

Miscellaneous
 Blood stream infectionAn infection not related to infection at another site, with a recognised pathogen cultured from blood cultures which is not related to an infection at another site
 CellulitisBacterial infection involving the skin
 Central line infectionInfected peripherally inserted central catheter (PICC) or central lines, confirmed by culture of line tip
 FractureAny fracture sustained postoperatively, diagnosed by plain film X-ray, CT or MRI
 Peripheral line infectionLocalised cellulitis (erythaema and swelling) around a peripheral cannula insertion site
 Pressure soreDecubitus ulcers, localised injuries to the skin and/or underlying tissue as a result of pressure usually over a bony prominence
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