Reporting and Grading of Complications after Urological Surgical Procedures: An ad hoc EAU Guidelines Panel Assessment and Recommendations

One year ago the EAU Guidelines Office formed an ad hoc committee to review the available reporting systems used for urological surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to systematically assess the Clavien-Dindo system (currently widely used for the reporting of complications related to urological surgical interventions), to identify shortcomings in reporting complications, and to present recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes.

The rationale for this came from the fact that no definitions for complications or guidelines for reporting surgical outcomes have been universally accepted in any field of surgery or its specialties, although the standardised classification and severity grading of surgical complications is essential for proper interpretation of surgical outcome data, for comparing the surgical outcomes between institutions or individual surgeons, and for comparing techniques in case randomised trials are either lacking or difficult to perform (i.e. comparison of minimally invasive techniques with open surgery).

The urological community seems to conform to the current demands for standardised classification and severity grading of surgical complications since recent studies more often use standardised criteria to report complications. The Clavien-Dindo system has gained wide acceptance both in general surgery and the urological community as shown by the exponential increase in the number of papers using it.

When reporting the outcomes of urological procedures the panel proposes to: a) explicitly define any complications, b) preferentially use a standardised system; the Clavien-Dindo grading system is highly recommended while the NCI-CTC system is recommended in multimodality treatments. By establishing universally accepted criteria for reporting surgical morbidities and outcomes, the quality of patient care is expected to improve and the comparison of different surgical techniques and therapeutic approaches to be easier and more trustworthy.

The committee also proposes a revision of the quality publication criteria introduced in 2002 that, most certainly, will aid all those involved in scientific publishing (authors, reviewers and editors), while making easier the assessment of the credibility of scientific reports.

Dionysios Mitropoulos (chairman), Walter Artibani, Markus Graefen, Mesut Remzi, Morgan Rouprêt, Michael Truss (members)