How to Grade? - Grey Zone Cases

Over the past five years, we were confronted with a couple of clinical cases, in which the grading of complications turned out to be difficult. Such cases were prospectively collected at our center.



Example of "grey zone cases"




Download our complication form:

Scenario 1:
A 63-year-old man underwent a right hemiliver resection for a hepatocellular carcinoma. The patient complained about right upper quadrant pain and developed a fever on postoperative day 4. A CT scan revealed an infected biloma in the right upper quadrant, which was drained percutaneously. After successful drainage of the biloma, the patient became acutely dyspnoeic due to a significant pneumothorax. A thorax drain was inserted to treat the pneumothorax.


Complication After a Surgical Procedure Not Caused by a Surgeon

This scenario describes a postoperative complication that is not caused by the surgical team responsible forthe patient; this may include complications after an intervention by the radiology or gastroenterology team. Although the “causative” physician is not a surgeon, the complication would not have occurred if the patient had not undergone surgery. Therefore, such postoperative events should be recorded irrespective of the team involved in caring for the patient.


The correct labeling of both complications presented in this scenario was biloma (grade IIIa) and pneumothorax (grade IIIa).