Table 4 Definitions of postoperative morbidity

Anastomotic leakage

Loss of integrity of the anastomosis, confirmed by appearance of contrast medium outside the anastomosis in the abdominal or pleural cavity after oral ingestion of contrast medium or by endoscopy

Leakage of the duodenal stump

Loss of integrity of the duodenal stump leading to diffusion of bile and pancreatic juice to the abdominal cavity

Pancreatic fistula

Drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than 3 times the serum amylase activity

Classification (according to the ISGPS definition):

Grade A: clinically not apparent, well condition, no infectious signs

Grade B: infectious sign but no sepsis, persistent drainage, no reoperation

Grade C: sepsis and/or reoperation necessary

Postoperative hemorrhage

Drop of systemic hemoglobin ≥3 g/dl compared to postoperative baseline level and/or need for transfusion of >2 units of packed red blood cells due to intraabdominal hemorrhage as indicated by blood loss via the abdominal drains and/or interventional treatment

Abscess

Closed collection of pus in the abdominal or pleural cavity

Wound healing problems

Leading to the necessity of a special wound care

Lymph fistula

Caused by damage of a lymphatic duct, leading to diffusion of chylus in the abdominal cavity. Diagnosis is done by measurement of triglyceride level in the abdominal drain. A triglyceride level three times higher than serum level is defined as lymphatic fistula.

Chylothorax

Accumulation of chylus in the thoracic cavity caused by damage of the thoracic duct or other intrathoracal lymphatic ducts

Tracheal lesions

Fistulas between esophagus and trachea, as well as loss of integrity of the tracheal wall

Deep vein thrombosis

Formation of a new thrombus in a deep vein, clinically evident (swollen/livid leg, pain), verified by Doppler ultrasound or CT angiography

Pulmonary embolisms

Emboli in the main pulmonary artery or its branches, clinically evident (tachypnea, tachycardia) and verified by CT angiography

Pulmonary infection

At least 3 of 4 of the following:

Temperature >37.5 °C

Purulent tracheal secretion

White blood count >12,000 or <4500/ml

Elevated CRP level

As well as radiological evidence of pulmonary infection

Renal failure

Renal failure of sudden onset after operation: doubling of preoperative serum, creatinine level, or need for dialysis or hemofiltration (in patients who were not on dialysis preoperatively)

Cerebral insult

Acute cerebral hypoperfusion, clinically evident by neurological symptoms, verified by cerebral CT scan and/or CT angiography

Myocardial infarction

Clinical symptoms of myocardial infarction as well as heart enzyme (troponin T) changes suggestive of myocardial infarction, changes in electrocardiogram for STEMIs, or evidence of myocardial infarction on coronary angiogram