A Systematic Review of Intra- and Postoperative Complication Reporting and Grading in Urological Surgery: Understanding the Pitfalls and a Path Forward

Context: Surgical outcomes and patient morbidity are often surrogate markers of health care quality and efficiency. These parameters can only be used with confidence if the reporting and grading of intra-and postoperative complications are reliable and repro-ducible. Without uniformity and regulation, the risk of under-reporting, and thus signif-icant underestimation of the burden of intra-and postoperative morbidity, is high and should be of great concern to the international surgical community.Objective: To assess the quality and utility of currently available reporting and classifi-cation systems for intra-and postoperative complications, recognise their advantages and pitfalls, discuss the overall implications of these systems for urological surgery, and identify potential solutions for future reporting and classification systems.Evidence acquisition: A comprehensive search was performed using multiple reputable databases and trial registries up to October 25, 2022. Only studies that adhered to pre-defined inclusion criteria were included. Study selection and data extraction were inde-pendently performed by two review authors. The review was performed according to strict methodological guidelines in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.Evidence synthesis: A total of 13 papers highlighting 13 various complication systems were critically assessed in this review. All studies proposed an intra-or postoperative complication reporting or grading system that was surgically related. At present, there is no single instrument in clinical practice to account for all relevant complication data. Six of the 13 studies were clinically validated (46%) and only three studies were urology -focused (23%). Meta-analysis was not possible.Conclusions: Current individual complication tools are flawed, so there is a need for a novel, all-inclusive, specialty-specific reporting and classification system for intra-and postoperative complications. If successfully validated and integrated worldwide, such an instrument would have the potential to play a significant role in reshaping efficiency in health care systems and improving surgical and patient quality of care.