Introduction
Methods
Results
Principle of grading | ||||||||
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I | II | IIIa | IIIb | IVa | IVb | V | Supplemental explanation of suffix “d” | |
AE term | Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, or radiological interventions. Allowed therapeutic regimens include drugs such as antiemetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside | Requirement for pharmacological treatment with drugs other than those allowed for grade I complications Blood transfusions and total parenteral nutrition are also included | Requirement for surgical, endoscopic or radiological intervention not under general anesthesia | Requirement for surgical, endoscopic or radiological intervention under general anesthesia | Life-threatening complications (including CNS complications)* requiring IC/ICU management. Single organ dysfunction (including dialysis) | Life-threatening complications (including CNS complications)* requiring IC/ICU management. Multiple organ dysfunction | Death of the patient | If the patient suffers from a complication at the time of discharge, the suffix “d” (for “disability”) is added to the respective grade of complication. This label indicates the need for a follow-up to fully evaluate the complication |
Stroke | Clinical observation only; intervention not indicated | Medical management indicated (e.g., anticoagulant therapy) | Radiological intervention without general anesthesia (e.g., intracerebrovascular treatment) | Intervention under general anesthesia indicated (e.g., drainage, surgical clipping, cerebrovascular bypass, carotid endarterectomy) | IC/ICU management indicated | IC/ICU management indicated; associated with respiratory failure | Death | Persistent hemiplegia |
Recurrent laryngeal nerve palsy | Clinical observation or diagnostic evaluation only; intervention not indicated | Aspiration; medical management indicated (e.g., antibiotics) | Severe aspiration; food intake almost impossible; medical intervention under local anesthesia indicated (e.g., vocal cord injection, tracheal puncture) | Intervention under general anesthesia indicated (including tracheostomy under sedation) | Mechanical ventilation indicated | Sepsis or multiple organ failure | Death | Hoarseness, difficulty in speaking; communication through writing necessary; discharged with tracheostomy |
Upper extremity paresthesia | Clinical observation only; intervention not indicated | Medical management indicated | Surgical intervention without general anesthesia indicated (e.g., nerve block) | – | – | – | – | Persistent brachial paresthesia |
Paresthesia in resected part (Phantom pain) | Clinical observation only; intervention not indicated | Medical management indicated | Surgical intervention without general anesthesia indicated (e.g., nerve block) | – | – | – | – | Persistent phantom pain |
Ischemic heart disease | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., anticoagulant therapy) | Cardiac catheterization indicated | Intervention under general anesthesia indicated (coronary artery bypass) | Heart failure associated with low cardiac output syndrome; IC/ICU management indicated | Heart failure associated with low cardiac output syndrome and renal failure; IC/ICU management indicated | Death | Persistent heart failure following myocardial infarction |
Pericardial effusion | Clinical observation or diagnostic evaluation only; intervention not indicated (drainage only through existing drainage tube) | Medical management indicated | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (fenestration) | Cardiac tamponade; IC/ICU management indicated | Cardiac tamponade and renal failure; IC/ICU management indicated | Death | – |
Bradyarrhythmia | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., atropine, β agonists) | Medical intervention under local anesthesia indicated (e.g., pacemaker implantation) | – | Heart failure associated with low cardiac output syndrome; IC/ICU management indicated | Heart failure associated with low cardiac output syndrome and renal failure; IC/ICU management indicated | Death | – |
Supraventricular arrhythmia | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antiarrhythmic drugs) | Medical intervention under local anesthesia indicated (e.g., catheter ablation, synchronized cardioversion) | – | Heart failure associated with low cardiac output syndrome; IC/ICU management indicated | Heart failure associated with low cardiac output syndrome and renal failure; IC/ICU management indicated | Death | – |
Ventricular arrhythmia | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antiarrhythmic drugs) | Medical intervention under local anesthesia indicated (e.g., catheter ablation, external defibrillator, pacemaker implantation) | – | Heart failure associated with low cardiac output syndrome; IC/ICU management indicated | Heart failure associated with low cardiac output syndrome and renal failure; IC/ICU management indicated | Death | – |
Atelectasis/sputum excretion difficulty | Clinical observation or diagnostic evaluation only; intervention not indicated, except for nebulizers, expectorants, or lung physiotherapy (e.g., postural drainage) | Medical management indicated (e.g., antibiotics) | Bronchoscopic aspiration or surgical intervention indicated (e.g., tracheal puncture) without general anesthesia | Intervention under general anesthesia indicated (including tracheostomy under sedation) | Mechanical ventilation indicated | Sepsis or multiple organ failure | Death | Discharged with tracheostomy |
Tracheal fistula, bronchial fistula | Clinical observation or diagnostic evaluation only; intervention not indicated | – | Procedure under local anesthesia indicated | Intervention under general anesthesia indicated | Mechanical ventilation indicated | Sepsis or multiple organ failure | Death | Discharged with tube drainage, open drainage |
Pulmonary fistula | Clinical observation or diagnostic evaluation only; intervention not indicated (drainage only through existing drainage tube) | – | Procedure under local anesthesia indicated (e.g., chest tube drainage, pleurodesis) including drain replacement indicated. | Intervention under general anesthesia indicated (Closure for pleuroparenchymal defects, pleurodesis) | Mechanical ventilation indicated | Sepsis or multiple organ failure | Death | Discharged with tube drainage, open drainage |
Chylothorax | Observation of chylous drainage fluid or thoracentesis fluid only (drainage only through existing drainage tube) | Fat-restricted diet, intravenous nutrition indicated | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (e.g., thoracic duct ligation) | – | – | Death | Persistent respiratory distress, malnutrition |
Pleural effusion | Clinical observation or diagnostic evaluation only; intervention not indicated (drainage only through existing drainage tube) | Medical management indicated (e.g., diuretics) | Image-guided drain placement/thoracentesis including drain replacement indicated | Intervention under general anesthesia indicated | Mechanical ventilation indicated | Multiple organ failure | Death | Persistent respiratory distress |
Lung torsion | – | – | – | Intervention under general anesthesia indicated (e.g., detorsion, lobectomy) | Mechanical ventilation indicated | Sepsis or multiple organ failure | Death | – |
Ascites | Clinical observation or diagnostic evaluation only; intervention not indicated (drainage only through existing drainage tube) | Medical management indicated (e.g., diuretics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated | – | – | Death | Persistent abdominal fullness |
Diarrhea | Intestinal fluid excretion ≥2000 ml/day; intervention not indicated | Intestinal fluid excretion ≥2000 ml/day associated with dehydration or electrolyte abnormality; intravenous fluids indicated | – | – | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Significant amount of persistent intestinal fluid excretion |
Dysphagia | Clinical observation only; intervention not indicated | Enteral/intravenous nutrition (Including TPN) indicated | Medical intervention under local anesthesia indicated (e.g., tracheal puncture, endoscopic gastrostomy) | Intervention under general anesthesia indicated | – | – | Death | Gastrostomy |
Intestinal fistula | Clinical observation or diagnostic evaluation only; intervention not indicated (drainage only through existing drainage tube) | Medical management indicated (e.g., antibiotics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (colostomy) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or renal disorders indicating dialysis) | Sepsis or multiple organ failure | Death | Persistent enterocutaneous fistula |
Intestinal ischemia/necrosis | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Radiological intervention/endoscopic/surgical intervention without general anesthesia indicated | Intervention under general anesthesia indicated (e.g., intestinal resection) | At least one organ failure (e.g., pulmonary disorders indicating mechanical ventilation or renal disorders indicating dialysis) | Sepsis or multiple organ failure | Death | Home enteral/intravenous nutrition |
Gastric tube necrosis | Observation of a small fistula with oral contrast study or drainage imaging (drainage only through existing drainage tube) | Medical management (e.g., antibiotics), enteral/intravenous nutrition indicated | Radiological intervention/endoscopic/elective surgical intervention without general anesthesia indicated, including drain replacement | Intervention under general anesthesia indicated | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | |
Reflux esophagitis | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management (e.g., PPI, pancreatic enzyme inactivators) or enteral/intravenous nutrition indicated | – | Intervention under general anesthesia indicated | – | – | Death | Persistent heartburn |
Ileus (paralytic) | Clinical observation or diagnostic evaluation only; medical management not indicated except for laxatives and intravenous nutrition | Medical management beyond laxatives, NG tube placement, or intravenous nutrition management indicated | Nasoenteric tube placement | Treatment for ileus under general anesthesia (with or without intestinal resection) | Extensive intestinal necrosis, at least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Home intravenous nutrition |
Pancreatic fistula | On or after postoperative day 3, drainage fluid amylase level ≥3 times the upper limit of institutional criteria, but intervention not indicated | Medical management indicated (e.g., antibiotics), enteral/intravenous nutrition indicated | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual pancreatic pseudocyst on CT, occasional fever, or abdominal pain |
Intestinal obstruction | Clinical observation or diagnostic evaluation only; medical management not indicated except for laxatives and intravenous nutrition | Medical management beyond laxatives, NG tube placement, or intravenous nutrition management indicated | Nasoenteric tube placement | Treatment for ileus under general anesthesia (with or without intestinal resection) | Extensive intestinal necrosis, at least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Home intravenous nutrition |
Delayed gastric emptying | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management (e.g., peristalsis stimulating drugs), NG tube placement, enteral/intravenous nutrition indicated | – | Intervention under general anesthesia indicated | – | – | Death | Persistent postprandial nausea |
Dumping syndrome | Clinical observation only; intervention not indicated | Medical management indicated | – | Intervention under general anesthesia indicated | – | – | Death | Persistent dumping symptom |
Biliary fistula | Clinical observation or diagnostic evaluation only; intervention not indicated (drainage only through existing drainage tube) | Medical management indicated (e.g., antibiotics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (drainage) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual pseudocyst on CT; occasional fever or abdominal pain |
Cholecystitis | Clinical observation or diagnostic evaluation only; medical management not indicated except for cholagogues | Medical management beyond cholagogues indicated | Medical intervention under local anesthesia indicated (e.g., Percutaneous transhepatic gallbladder drainage) | Intervention under general anesthesia indicated (cholecystectomy) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Occasional fever or abdominal pain |
Gastrointestinal anastomotic leak | Only small fistula observed on oral contrast study or drainage imaging (drainage only through existing drainage tube) | Medical management (e.g., antibiotics) or enteral/intravenous nutrition (Including TPN) indicated | Image-guided drain placement/paracentesis including wound opening or drain replacement indicated | Intervention under general anesthesia indicated (e.g., suture, reanastomosis, bypass, drainage, colostomy) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Home enteral/intravenous nutrition |
Ureteric injury | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Transurethral ureteral stent insertion or percutaneous nephrostomy | Intervention under general anesthesia indicated | Acute renal failure, hemodialysis | Sepsis or multiple organ failure | Death | Discharged with ureteral stent |
Urethral injury | Foley catheter placement | Medical management indicated (e.g., antibiotics) | Intervention under local or lumbar anesthesia indicated (e.g., percutaneous cystostomy) | Intervention under general anesthesia indicated | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Discharged with Foley catheter placement |
Postoperative hemorrhage | Controllable with compression only | Blood transfusion or medical management indicated | Surgical hemostasis under local anesthesia or endoscopic and radiological intervention hemostasis indicated | Intervention under general anesthesia indicated (hemostasis) | Single organ failure; stepdown ICU/ICU care indicated | Multiple organ failure; IC/ICU management indicated | Death | Persistent anemia |
Seroma (Accumulation of serous fluid) | Bedside paracentesis only (drainage only through existing drainage tube) | – | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Exudate leakage from wound, occasional fever and infection, discharged with drainage tube |
Uterine anastomotic leak | Clinical or vaginal observation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | – | Intervention under general anesthesia indicated (resuturing) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Persistent leakage from uterovaginal anastomosis due to suture failure (surgical union of two different anatomical structures) |
Abdominal incisional hernia | Clinical observation only; intervention not indicated except for truss and NSAIDs | Medical management beyond truss and NSAIDs indicated | Medical intervention under local anesthesia indicated | Intervention under general anesthesia indicated (mesh, fascial resuturing) | Extensive intestinal necrosis, at least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Intestinal prolapse upon increased intra-abdominal pressure |
Wound dehiscence | Clinical observation only; intervention not indicated except for wound irrigation | Medical management indicated (e.g., antibiotics) | Medical intervention under local anesthesia indicated (e.g., resuturing) | Intervention under general anesthesia indicated (e.g., resuturing) | Extensive intestinal necrosis, at least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Discharged with significant wound dehiscence |
Gastrointestinal anastomotic stenosis | Clinical observation or diagnostic evaluation only; intervention not indicated | Enteral/intravenous nutrition (Including TPN) indicated | Balloon dilatation, stenting, magnetic compression anastomosis | Intervention under general anesthesia indicated (e.g., reanastomosis, bypass) | – | – | Death | Frequent outpatient endoscopic dilatation |
Intraabdominal abscess | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (drainage) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on CT, occasional fever or abdominal pain |
Pelvic abscess | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (drainage) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on CT, occasional fever or abdominal pain |
Pneumonia | Clinical observation or diagnostic evaluation only; intervention not indicated except for nebulizers, expectorants, or lung physiotherapy (e.g., postural drainage) | Medical management indicated (e.g., antibiotics) | Bronchoscopic aspiration, tracheal puncture | Tracheostomy under general anesthesia/sedation or mechanical ventilation | Mechanical ventilation indicated | Sepsis or multiple organ failure | Death | Persistent respiratory distress, occasional fever |
Mediastinitis | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (drainage) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on CT images, occasional fever or abdominal pain |
Pyothorax | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated (drainage) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on CT images or discharged with tube drainage, open drainage |
Lower extremity lymphangitis (Lymph node infection) | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Medical intervention under local anesthesia indicated (lymphatic anastomosis) | Intervention under general anesthesia indicated (lymphatic anastomosis) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | – | Persistent edema |
Infected lymphocele (Retroperitoneal abscess) | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Drainage under local anesthesia or without anesthesia indicated | Intervention under general anesthesia indicated (incision and drainage) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on imaging study, occasional fever or abdominal pain |
Infectious cervicitis | Clinical or vaginal observation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Drainage under local anesthesia or without anesthesia indicated | Intervention under general anesthesia indicated (drainage, hysterectomy) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Persistent infected vaginal discharge |
Uterine infection | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Dilation and curettage under local anesthesia or without anesthesia indicated | Intervention under general anesthesia indicated (drainage, hysterectomy) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on imaging study, occasional fever or abdominal pain |
Ovarian infection | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Paracentesis drainage under local anesthesia indicated | Intervention under general anesthesia indicated (drainage, oophorectomy) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on imaging study, occasional fever or abdominal pain |
Vulval infection | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Paracentesis drainage under local anesthesia indicated | Intervention under general anesthesia indicated (drainage, skin flap, or musculocutaneous flap) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Residual abscess on imaging study, occasional fever or abdominal pain |
Wound infection | Clinical observation or diagnostic evaluation only; intervention not indicated, except for wound opening and wound irrigation at the bedside | Medical management indicated (e.g., antibiotics) | Medical intervention under local anesthesia indicated (e.g., drainage) | Intervention under general anesthesia indicated (e.g., drainage, resuturing) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Continued outpatient irrigation |
Implant infection | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Medical intervention under local anesthesia indicated (e.g., incision and drainage, implant removal) | Intervention under general anesthesia indicated (implant removal) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Discharged with drainage tube placement; persistent infection |
Bladder injury | Foley catheter placement indicated | Medical management indicated (e.g., antibiotics) | – | Intervention under general anesthesia indicated | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Discharged with Foley catheter placement |
Urinary incontinence | Intermittent catheterization or Foley catheter placement indicated | Medical management indicated (e.g., anticholinergics) | Intervention under local or lumbar anesthesia indicated (e.g., clamp, collagen injection) | Intervention under general anesthesia indicated (e.g., artificial urinary sphincter) | Acute renal failure, hemodialysis | Sepsis or multiple organ failure | Death | Persistent condition requiring Intermittent catheterization; Discharged with Foley catheter placement |
Residual urine/Urinary retention | Intermittent catheterization or Foley catheter placement indicated | Medical management indicated (e.g., cholinergics) | Intervention under local or lumbar anesthesia indicated (e.g., endoscopic treatment, urethral dilatation) | Intervention under general anesthesia indicated (e.g., fistula closure) | Acute renal failure, hemodialysis | Sepsis or multiple organ failure | Death | Persistent condition requiring intermittent catheterization; Discharged with Foley catheter placement |
Dyspareunia | Discomfort associated with vaginal penetration; intervention not indicated | Estrogen administration indicated | Medical intervention under local anesthesia indicated | Intervention under general anesthesia indicated | – | – | – | Persistent pain associated with sexual intercourse, persistent dyspareunia |
Erectile dysfunction | Erectile dysfunction; intervention not indicated, except for external vacuum device for managing erectile dysfunction | Medical management indicated (e.g., Phosphodiesterase 5 inhibitors or intracavernosal injection of vasoactive agonists) | Intervention under local or lumbar anesthesia indicated | Intervention under general anesthesia indicated (e.g., penile prosthesis) | – | – | – | Persistent erectile dysfunction |
Cervical atresia (uterine atresia) | Clinical or vaginal observation only; intervention not indicated | Associated with dysmenorrhea; medical management indicated (e.g., analgesics) | Bougienage of cervical duct with or without local anesthesia indicated | Intervention under general anesthesia indicated (cervical dilatation) | – | – | – | Persistent stenosis of the cervical os |
Vaginal fistula | Clinical or vaginal observation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | – | Intervention under general anesthesia indicated (vaginal fistula closure, colostomy) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Persistent leakage from vagina |
Ovarian deficiency syndrome | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., hormone replacement therapy) | – | – | – | – | Death | Hot flash requiring continued hormone replacement therapy, depression requiring continued psychiatric care |
Cervical chylous leakage | Observation of chylous drainage fluid or paracentesis fluid only; intervention not indicated (drainage only through existing drainage tube) | Fat-restricted diet, intravenous nutrition indicated | Image-guided drain placement/paracentesis including drain replacement indicated. | Intervention under general anesthesia indicated | – | – | Death | Persistent sensation of pressure in the neck |
Serous leakage | Clinical observation only; intervention not indicated (drainage only through existing drainage tube) | Medical management indicated (e.g., antibiotics) | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Exudate leakage from the wound, occasional fever and infection, discharged with drainage tube |
Chylous ascites | Observation of chylous drainage fluid or paracentesis fluid only; intervention not indicated (drainage only through existing drainage tube) | Fat-restricted diet, intravenous nutrition indicated | Image-guided drain placement/paracentesis including drain replacement indicated | Intervention under general anesthesia indicated | – | – | Death | Persistent abdominal fullness |
Subcutaneous phlebitis (Mondor disease) | Clinical observation or diagnostic evaluation only; intervention not indicated except for NSAIDs | Opioid administration, or treatment by pain control specialist indicated | Medical intervention under local anesthesia indicated | Intervention under general anesthesia indicated | – | – | – | Surgical site subcutaneous phlebitis; cord-like mass |
Thrombosis/embolism | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., anticoagulants) | Invasive treatment indicated (e.g., thrombus ablation via catheter, IVC filter) | Intervention under general anesthesia indicated (pulmonary artery thrombectomy) | Single organ failure caused by thrombi (e.g., lung, brain, heart) | Multiple organ failure caused by thrombi (e.g., lung, brain, heart) | Death | Dyspnea following pulmonary infarction, paralysis following cerebral infarction |
Restricted shoulder joint range of motion | Clinical observation only; intervention not indicated except for NSAIDs | Opioid administration, or treatment by pain control specialist indicated | Surgical intervention without general anesthesia indicated (e.g., nerve block) | Intervention under general anesthesia indicated | – | – | – | Continued restriction in the range of motion of the shoulder joint |
Fat necrosis | Clinical observation or diagnostic evaluation only; intervention not indicated except for wound opening and wound irrigation at the bedside | Medical management indicated (e.g., antibiotics) | Medical intervention under local anesthesia indicated (e.g., incision and drainage) | Intervention under general anesthesia indicated | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Wound fat necrosis, occasional cicatrization, fever or infection |
Skin necrosis (flap necrosis) | Clinical observation or diagnostic evaluation only; intervention not indicated | Medical management indicated (e.g., antibiotics) | Medical intervention under local anesthesia indicated (e.g., debridement, skin grafting) | Intervention under general anesthesia indicated (skin grafting) | At least one organ failure (e.g., pulmonary disorders requiring mechanical ventilation or nephropathy indicating dialysis) | Sepsis or multiple organ failure | Death | Insufficient epithelialization, persistent infection |
Subcutaneous emphysema | Clinical observation or diagnostic evaluation only; intervention not indicated except for subcutaneous puncture and compression with breast band at the bedside | – | Radiological intervention treatment without general anesthesia indicated (e.g., subcutaneous drain insertion) | Intervention under general anesthesia indicated | – | – | – | Discharged with subcutaneous air accumulation |
Upper extremity edema | Intervention not indicated except for lymphatic massage and elastic stockings | Medical management indicated (e.g., diuretics) | Intervention under local anesthesia indicated (lymphatic anastomosis) | Intervention under general anesthesia indicated (lymphatic anastomosis) | – | – | – | Continued elastic stocking use |
Lower extremity lymphedema (edema of the extremities, lymphedema, localized edema) | Intervention not indicated except for lymphatic massage and elastic stockings | Medical management indicated (e.g., diuretics) | Intervention under local anesthesia indicated (lymphatic anastomosis) | Intervention under general anesthesia indicated (lymphatic anastomosis) | – | – | – | Continued elastic stocking use |
Obturator/femoral neuropathy (Gait disturbance) | Intervention not indicated except for walking aid and rehabilitation | Medical management indicated (e.g., vitamins) | – | Intervention under general anesthesia indicated (e.g., nerve suture) | – | – | – | Persistent restriction in lower extremity adduction |
Wound pain | Clinical observation only; intervention not indicated except for NSAIDs | Opioid administration, or treatment by pain control specialist indicated | Surgical intervention indicated (e.g., nerve block) | – | – | – | – | Home pain control |
Others (No AE term) | Deviation from normal postoperative course. Medication, surgical intervention, endoscopic treatment, or radiological intervention treatment not indicated Treatment with antiemetics, antipyretics, analgesics, or diuretics; electrolyte replenishment; or physical therapy is not included in this category (even if these treatments are indicated, the condition is categorized as Grade I); open wound infection at the bedside is Grade I | Medication indicated except for antiemetics, antipyretics, analgesics, and diuretics Cases requiring blood transfusion or intravenous hyperalimentation are included | Surgical, endoscopic, or radiological intervention treatment indicated (without general anesthesia) | Surgical, endoscopic, radiological intervention treatment indicated (intervention under general anesthesia) | IC/ICU management indicated; life-threatening complications (including complications in the central nervous system) AND single organ failure (including dialysis) | IC/ICU management indicated; life-threatening complications (including complications in the central nervous system) AND multiple organ failure | Death |
CTCAE ver4.0 | Clavien-Dindo classification | JCOG PC criteria | |
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AE terms | Specified | Not specified | Specified |
Grading definitions | Defined for each AE | Single common definition for all AEs | Defined for each AE (following the general definition of the Clavien-Dindo classification) |