РЕЗЮМЕ
Объективная и стандартизированная оценка осложнений после абдоминальных хирургических вмешательств имеет важное значение для сопоставления хирургических результатов и повышения качества лечения. Целью данного обзора является анализ клинического применения основных классификационных систем, используемых для оценки послеоперационных осложнений. В работе в сравнительном аспекте рассмотрены принципы формирования, преимущества и ограничения классификации Клавьена–Диндо, системы оценки тяжести осложнений Аккордеон и Комплексного индекса осложнений. Показано, что целенаправленное использование различных классификационных подходов позволяет более точно оценивать послеоперационные результаты и способствует повышению качества хирургической помощи.
Keywords: абдоминальная хирургия, послеоперационные осложнения, классификация осложнений, хирургические результаты, качество лечения

---

ЛИТЕРАТУРА

1. Dindo D, Demartines N, Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey // Ann Surg. 2004; 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
2. Dindo D, Clavien P.A. What is a surgical complication? // World J Surg. 2008; 32:939–941. https://doi.org/10.1007/s00268-008-9584-y
3. Sokol DK, Wilson J. What is a surgical complication? // World J Surg. 2008; 32:942–944. https://doi.org/10.1007/s00268-008-9471-6
4. Tevis S.E, Kennedy G.D. Postoperative complications and implications on patient-centered outcomes // J Surg Res. 2013; 181:106–113. https://doi.org/10.1016/j.jss.2013.01.032
5. Clavien P.A, Barkun J, de Oliveira M.L, et al. The Clavien-Dindo classification of surgical complications: five-year experience // Ann Surg. 2009; 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
6. Park J.H, Kim D.J, Kim M.H, Park J.K, Choi S.H, Lee S. Validation of comprehensive complication index in the general surgery department of a small-volume hospital: a prospective observational study // Asian J Surg. 2019; 42:1009–1016 https://doi.org/10.1016/j.asjsur.2019.06.003
7. Tirotta F, Parente A, Richardson T, et al. Comparison of comprehensive complication index and Clavien-Dindo classification in patients with retroperitoneal sarcoma // J Surg Oncol. 2021; 124:1166–1172. https://doi.org/10.1002/jso.26612
8. Kim TH, Suh YS, Huh YJ, et al. The comprehensive complication index is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery // Gastric Cancer. 2018; 21:171–181. https://doi.org/10.1007/s10120-017-0728-3
9. Veličković J, Feng C, Palibrk I, et al. The assessment of complications after major abdominal surgery: a comparison of two scales // J Surg Res. 2020; 247:397–405. https://doi.org/10.1016/j.jss.2019.10.003
10. Veličković J, Feng C, Palibrk I, et al. Assessment of postoperative complications after major abdominal surgery using Clavien–Dindo classification and Comprehensive Complication Index //J Surg Res. 2022; 272:45–53. https://doi.org/10.1016/j.jss.2021.11.012
11. Yamashita S, Sheth R.A, Niekamp A.S, et al. Comprehensive complication index predicts length of stay and mortality after major abdominal surgery // Ann Surg Open. 2021; 2: e 048. https://doi.org/10.1097/AS9.0000000000000048
12. Staiger R.D, Schwandt H, Puhan M.A, et al. Improved surgical outcomes assessment by the Comprehensive Complication Index: a prospective study // Br J Surg. 2020; 107:1343–1351. https://doi.org/10.1002/bjs.11677
13. Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity // Ann Surg. 2013; 258:1–7. https://doi.org/10.1097/SLA.0b013e318296c732
14. Strasberg S.M., Linehan D.C., Hawkins W.G. The Accordion Severity Grading System of surgical complications // Ann Surg. 2009; 249 (2):177186. https://doi.org/10.1097/SLA.0b013e31818e4512
15. Strasberg S.M. Severity grading of surgical complications: the Accordion system // J Am Coll Surg. 2009; 208(3): S1–S5. https://doi.org/10.1016/j.jamcollsurg.2008.12.005
16. Bolliger M., Kroehnert J.A., Molineus F., et al. Experiences with the Comprehensive Complication Index as a measure of postoperative morbidity // Ann Surg. 2018;267(6):1047–1052. https://doi.org/10.1097/SLA.0000000000002324
17. Rosenthal R., Hoffmann H., Clavien P.A., et al. Definition and classification of intraoperative complications // Ann Surg. 2015;261(3):551-558. https://doi.org/10.1097/SLA.0000000000000854
18. Krell R.W., Girotti M.E., Dimick J.B. Extended length of stay after surgery: complications, inefficient care, or sick patients? // Ann Surg. 2014;259(2):286–291. https://doi.org/10.1097/SLA.0000000000000303
19. Pearse R.M., Moreno R.P., Bauer P., et al. Mortality after surgery in Europe: a 7-day cohort study // Lancet. 2012; 380(9847):1059–1065. https://doi.org/10.1016/S0140-6736(12)61148-9
20. Ghaferi A.A., Birkmeyer J.D., Dimick J.B. Variation in hospital mortality associated with inpatient surgery //Ann Surg. 2009; 250(5):683688. https://doi.org/10.1097/SLA.0b013e3181b9b6f5
21. Jammer I., Wickboldt N., Sander M., et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine // Br J Anaesth. 2015;115(6):760–771. https://doi.org/10.1093/bja/aev381
22. Nederlof N., Slaman A.E., van Hagen P., et al. Using postoperative morbidity metrics to evaluate surgical outcomes // Br J Surg. 2016;103(9):1141-1149. https://doi.org/10.1002/bjs.10177
23. Dimick J.B., Pronovost P.J., Cowan J.A., et al. Postoperative complications: a systematic review of failure to rescue. Ann Surg. 2004;239(4):475–482. https://doi.org/10.1016/S1072-7515(03)00122-4
24. Hall B.L., Hamilton B.H., Richards K., et al. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program? Ann Surg. 2009; 250(3):363–376. https://doi.org/10.1097/SLA.0b013e3181b4148f
25. Birkmeyer J.D., Finks J.F., O’Reilly A., et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369(15):1434-1442 https://doi.org/10.1056/NEJMsa1300625