Perception of surgical complications among patients, nurses and physicians: a prospective cross-sectional survey

Ksenija Slankamenac, Rolf Graf, Milo A Puhan, Pierre-Alain Clavien, Ksenija Slankamenac, Rolf Graf, Milo A Puhan, Pierre-Alain Clavien

Abstract

Background: Several scores grade the severity of post-operative complications but it is unclear whether such scores truly reflect the perception of patients and practicing nurses and physicians.

Study design: 227 patients, 143 nurses and 245 physicians independently rated the severity of 30 common post-operative complications on a numerical analogue scale from 0 (not severe at all) to 100 (extremely severe) while being blinded towards the Clavien-Dindo classification. We considered a difference in ratings of >10 to be clinically important in distinguishing between grades of severity and groups. We evaluated the level of reproducibility of responses by calculating intraclass correlation coefficients (ICC) and compared scores across severity grades and between groups using the generalized estimating equations.

Results: Reproducibility of the ratings was good for all three groups (ICCpatients 0.71 (95%-CI 0.64-0.76), ICCnurses 0.83 (0.78-0.87) and ICCphysicians 0.87 (0.83-0.90)). The participants' perceptions of the severity of complications reflected the Clavien-Dindo classification (median of grade I: 20 (IQR 10-30), grade II: 40 (31.3-52.5), grade IIIa: 50 (40-60), grade IIIb: 70 (60-75), grade IVa: 85 (80-90) and grade IVB: 95 (90-100)). Although patients' perception differed significantly from those of physicians (average difference -8.7 (95%-CI -10.4 to -6.9, p < 0.001) and nurses (difference -2.8 (-4.8 to -0.8, p = 0.007) they did not reach our thresholds for clinical importance.

Conclusions: The severity of post-operative complications is perceived similarly by patients, nurses and physicians and reflects the Clavien-Dindo classification well. Our results support the use of Clavien-Dindo classification system as part of the shared or informed decision making process.

Figures

Figure 1
Figure 1
Study flow.
Figure 2
Figure 2
Perception of the severity of post-operative complications from all participants: The questionnaire included 30 scenarios with five scenarios for each severity grade according to the Clavien-Dindo classification. The box plots represent the median, interquartile range and 95%-confidence interval for all scenarios rated within each grade of the Clavien-Dindo classification. The perception of the severity of post-operative complications of all participants (patients, nurses and physicians) increases with the rise in the Clavien-Dindo classification.
Figure 3
Figure 3
Patients', nurses' and physicians' perception of the severity of post-operative complications: The box plots represented the median, interquartile range and 95%-confidence interval for all scenarios rated within each grade of the Clavien-Dindo classification and compares the three groups of participants (patients, nurses and physicians). Patients, nurses and physicians graded the complication scenarios similarly across all grades of the Clavien-Dindo classification (I to IVB) (Figure 3).

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