Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery

Aims of the studyWe aimed to assess postoperative complications prospectively on a daily basis and hypothesized that this would lead to an increase in the number of detected complications.MethodsSurgical complications were assessed prospectively during a period of 8 months. Systematic documentation was carried out daily during a team meeting (period S). Data were compared to those of a preceding period of 8-months of nonsystematic assessment (period N) in which complications had been documented in a self-reporting fashion. Complications were classified according to the Clavien–Dindo classification.ResultsA total of 1291 patients (mean age: 6.6 years) were included. During period S complications were determined in 16% of 790 operations compared to 4% of 741 procedures in period N (p < 0.01). This difference was owing to an increased detection of minor complications (grade I–III), i.e. wound infection, dysuria after hypospadias repair or postoperative bleeding. In contrast, the incidence of severe complications (grade IV + V) was not significantly different between the time periods (1.3% in period S and 0.8% in period N). Most frequent major complications were cardiopulmonary arrest, enterocolitis, and death. Severe complications accounted for 8% of complications discussed during weekly morbidity and mortality conferences in period S versus 22% in period N (p < 0.05).ConclusionOur results indicate that a systematic documentation of complications on a daily basis reveals a more realistic picture of the incidence of pediatric surgical complications and should be the method of choice.