The primary aim of the present thesis was to study how surgical quality can be measured in a single hospital, by creating and describing a simple and usable tool for registering outcomes data based on severity of complications.
First, a systematic review of the subject was conducted. The evaluation of the articles revealed wide methodological heterogeneity in the classification and categorization of complications and data collection methods. Subsequently, a pilot hospital-wide surgical complication register was created and implemented in Satasairaala, Pori, Finland.
Perioperative data related to all adult general and orthopedic surgery procedures for 3 years (2016–2018) were included in the study. Complications were recorded according to a modified Clavien–Dindo classification, and the preoperative risk factors were compiled based on the literature and coded as numerical measures. The overall complication rate in 4529 patients was 17.2% (95% confidence interval (CI) 16.1–18.3), and 4.6% (95% CI 4.0–5.2) were graded as major complications. The results also showed that only a few patient-related risk factors were sufficient to account for the case mix.
Further aims of this thesis were to study factors associated with patient education and patient perceptions on surgical quality, and their association with surgical complications. Adult patients undergoing surgical operations were studied by questionnaires in 2016–2017 in Satasairaala, Pori. The results indicate that the information needs of the patients vary individually. The level of received information by patient education and the patient perception on quality of care may have an association with reported surgical complications.