Definition and classification of complications of gastrectomy for gastric cancer based on the accordion severity grading system

Abstract

Background: Postoperative complications still comprise the marker used most frequently to assess the quality of gastrectomy. However, the definition and grading of morbidity is not standardized, hampering meaningful comparisons over time and among centers. This study proposes specific definitions and a reproducible classification of complications following gastrectomy using standardized grading tools.

Methods: We defined each complication based on the literature, and adopted the Accordion Severity Grading System to stratify morbidity. The classification was applied to 890 patients with gastric cancer seen between January 2010 and April 2011. The correlation between the complication grades and the length of hospital stay (LOS) was analyzed, and risk factors for complications were examined with special reference to severity grade.

Results: The overall morbidity rate was 18.1 %. Mild complications occurred in 31 patients (3.5 %), moderate in 77 patients (8.7 %), severe--invasive procedure/no general anesthesia (GA) in 27 patients (3.0 %), severe--invasive procedures/GA in 18 patients (2.0 %), and severe--organ failure in 3 patients (0.3 %). Five patients (0.6 %) died postoperatively. The grade of complications had a significant effect on the LOS (p < 0.001). Operating time and cardiovascular and pulmonary co-morbidities were independent risk factors for severe complications [odds ratio (OR) 1.001, p = 0.016; OR 2.226, p = 0.006; OR = 2.896, p = 0.003, respectively].

Conclusions: The complications after gastrectomy could be classified into different severity grades that had distinct clinical outcomes. The use of this classification provides more reliable, practical outcome data. Consequently, complications should be reported using a standardized classification tool such as the Accordion Severity Grading System, which requires consensus on the definition of specific complications.