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Epidemiology, Biostatistics and Prevention Institute

Peri-Operative Outcome Research

Peri-Operative Outcome Research

Peri-Operative Outcome Research In 2008, the World Health Organization (WHO) has recognized that surgical complications account for a large proportion of preventable medical injuries and deaths globally and deemed it a global public health issue. Over 200 million operations are conducted worldwide every year. Up to 16% suffer from post-surgery complications. In Switzerland, there are over one million patients hospitalized every year and almost half of them are treated with surgery or another at least minimally invasive medical intervention. Postoperative complications can cause severe reduction in quality of life for patients and are also a major driver for healthcare costs. Measuring healthcare outcomes in and after surgery, however, is challenging. To compare different postoperative treatment paths or new surgical techniques, or to define the required minimum case volume for a hospital, researchers and clinicians lack convincing and standardized endpoints as well as sufficient research funding. As safety of surgery has improved dramatically over the last decades the postoperative mortality is very low. The focus has shifted to the still substantial postoperative burden from complications, that may, depending on the type of procedure, occur up to two years after surgery. Complications have become a key indicator of surgical quality and early recognition of complications are highly predictive for the entire postoperative burden and may be used for timely preventive interventions. They present a huge burden for the patient, the doctor and are also directly connected to raising health care costs.

At the EBPI, we have a research focus on perioperative and more long-term outcomes of surgery. We develop instruments to measures postoperative outcomes and means to reduce surgical complications together with our colleagues from surgery and perioperative medicine. We currently work on the following projects: Instruments to measure postoperative outcomes We developed a new index with the inclusion of the Clavien-Dindo classification, which now summarizes all postoperative complications in a single continuous number, the Comprehensive Complication Index (CCI®). The CCI addressed the need to capture the entire postoperative burden and not just single complications. The CCI® is based on the complication grading by the Clavien-Dindo Classification and captures every complication that occurred after an intervention. The overall morbidity is returned on a scale from 0 (no complication) to 100 (death) and reflects the gravity of this overall complication burden on the patient. The CCI® was developed together with patients to ensure the patients’ perspective is represented in the scale. In order to be able to calculate the CCI® easily and quickly in clinical practice, the team has set up a website with an online CCI We currently have projects to further develop the CCI and implement it in surgical practice.

Benchmarking in surgery “Benchmarking"
Means comparing one's own business processes and key performance indicators with the best practices of other companies. The dimensions typically measured are quality, time and costs. Applied to surgery, this involves defining the best possible outcomes, for example in major liver surgeries or liver transplants. The introduction of standardized benchmarks for complex procedures can lead to improved patient outcomes or surgical performance and ultimately reduce costs. We currently have projects to apply and further develop the approach to benchmarking in surgery. PubMed Link to publications on surgical outcome assessment and benchmarking: Link to website:here

Outcome4Medicine Consensus Conference (June 2022)
With the OUTCOME4MEDICINE initiative, we brought together evidence and expertise from around the world and let a jury of citizen non-experts find a consensus on how outcomes after medical interventions should be assessed, interpreted, and communicated to the public to further improve patient-centered surgical care.. We followed a proven format involving evidence reports from experts, conducted by 9 panels representing different perspectives. At the OUTCOME4MEDICINE conference, the experts presented their findings in individual sessions and answered questions from the jury and audience creating the basis for an interactive dialogue between scientists and the attending public. This created a truly innovative way to build bridges between healthcare providers, patients, and policy makers for a more fruitful and open communication. The non-expert citizen jury members for OUTCOME4MEDICINE were selected in regard to their various and complementary profiles but without direct background in outcome research for developing final and unbiased recommendations. The main publication of the conference will be published in 2023. Link to website: here

Weiterführende Informationen


Milo Puhan (Project Leader)
Anja-Rebeka Domenghino
Roxane Staiger
Pierre-Alain Clavien
Salome Kuster
Fariba Abbassi