ECCG - Complication definitions

Pulmonary

  • Pneumonia
    The presence of a new or progressive radiographic infiltrate plus at least two of three following clinical features.
1. Fever greater than 38°C 
2. Leukocytosis or leukopenia
3. Purulent secretions
  • Pleural effusion requiring additional drainage procedure
  • Pneumothorax requiring intervention
  • Atelectasis mucous plugging requiring bronchoscopy
  • Respiratory failure requiring reintubation
  • Acute respiratory distress syndrome
  • Acute aspiration
  • Tracheobronchial injury
  • Chest tube drainage for >10 days post-op

Urologic

  • Acute renal insufficiency (Defined as: doubling of baseline creatinine)
  • Acute renal failure requiring dialysis
  • Urinary tract infection
  • Urinary Retention requiring reinsertion of urinary catheter, delaying discharge or discharge with urinary catheter

Thromboembolic

  • DVT (deep venous thrombosis)
  • PE (pulmonary embolus)
  • Stroke (CVA)
  • Peripheral Thrombophlebitis

Cardiac

  • Cardiac arrest requiring CPR
  • Myocardial infarction
  • Dysrhythmia atrial requiring intervention
  • Dysrhythmia ventricular requiring intervention
  • Congestive heart failure requiring intervention
  • Pericarditis requiring intervention

Infection

  • Wound Infection requiring opening wound or antibiotics
  • Central IV line infection requiring removal or antibiotics
  • Intrathoracic/intra-abdominal abscess
  • Generalized sepsis – CDC definition
  • Other infections requiring antibiotics

Wound / Diaphragm

  • Thoracic wound dehiscence
  • Acute abdominal wall dehiscence / hernia
  • Acute diaphragmatic hernia

Gastrointestinal

  • Esophagogastric leak from anastomosis, staple line or localized conduit necrosis

    • Defined as: Full thickness GI defect involving esophagus, anastomosis, staple line, or conduit irrespective of presentation or method of identification

      Type I: Local defect requiring no change in therapy or treated medically or with dietary modification

      Type II: Localized defect requiring interventional but not surgical therapy, for example, interventional radiology drain, stent or bedside opening, and packing of incision

      Type III: Localized defect requiring surgical therapy

  • Conduit necrosis/failure requiring surgery

    • Type I: Conduit necrosis focal Identified endoscopically (Treatment—Additional monitoring or non-surgical therapy)

      Type II: Conduit necrosis focal Identified endoscopically and not associated with free anastomotic or conduit leak (Treatment—Surgical therapy not involving esophageal diversion)

      Type III: Conduit necrosis extensive (Treatment—Treated with conduit resection with diversion)

  • Ileus requiring intervention
  • Small bowel obstruction
  • Feeding J-tube complication
  • Pyloromyotomy / pyloroplasty complication
  • Clostridium difficile Infection
  • GI bleeding requiring intervention or transfusion
  • Delayed gastric emptying requiring intervention or delaying discharge or requiring maintenance of NG drainage >7 days post-op
  • Pancreatitis
  • Liver dysfunction

Neurologic / Psychiatric

  • Recurrent laryngeal nerve injury

    • Defined as: Vocal cord dysfunction post-resection. Confirmation and assessment should be by direct examination

      Type I: Transient injury requiring no therapy

      Dietary modification allowed

      Type II: Injury requiring elective surgical procedure, for example, thyroplasty or medialization procedure

      Type III: Injury requiring acute surgical intervention (due to aspiration or respiratory issues), for example, thyroplasty or medialization procedure

      Severity Level

      (A) Unilateral

      (B) Bilateral

      For example, a unilateral vocal cord injury requiring elective medialization procedure. Final Type IIA

  • Other neurologic injury
  • Acute delirium
  • Delirium tremens

Other complications

  • Chyle leak
    • Type I: Treatment—enteric dietary modifications​
    • Type II: Treatment—total parenteral nutrition
    • Type III: Treatment—interventional or surgical therapy

Severity Level

(A) <1 liter output/day

(B) >1 liter output/day
(e.g. chyle leak initially producing 1200 ml/day and successfully treated by stopping enteric feeds and initiating TPN. Final Type IIB)

  • Reoperation for thoracic bleeding
  • Reoperation for abdominal bleeding
  • Reoperation for reasons other than bleeding, anastomotic leak or conduit necrosis
  • Multisystem organ failure