Table 1 Major postoperative complications: definition and criteria

SIRS

Two or more of the following:

Temperature >38 °C or <36 °C

Heart rate >90 beats/min

Respiratory rate >20/min or PaCO2 < 4,3kPa

White blood cell count >12000 cell/ml or

<4000 cells/ml or >10 % immature forms

Bacteraemia

At least one positive blood culture of pathogenic organisms

Sepsis

SIRS + bacteraemia

Pneumonia

X-ray confirmed and necessitating antibiotic treatment

Anastomotic leak

Necessitating re-operation or demonstrated upon autopsy

Bowel obstruction, necrosis or perforation

Necessitating re-operation or demonstrated upon autopsy

Intra abdominal abscess

Necessitating re-operation or percutaneous drainage or demonstrated upon autopsy

Intra abdominal haemorrhage

Necessitating re-operation, transfusion of six or more units of Packed Red Blood Cells within first 48 h postop. or demonstrated upon autopsy

Wound rupture

Necessitating re-suturing in general anesthesia or demonstrated upon autopsy

Pancreatitis

Serum enzyme level twice upper normal value, absence of known pre-existing pancreatitis, ERCP or mechanical trauma to pancreas during operation providing satisfactory explanation for elevated enzymes

Cholecystitis

Confirmed by histological examination of specimen or by cultured content from percutaneous drainage

Myocardial infarction

Diagnostic enzyme pattern and either typical pain or ECG changes, or demonstrated upon autopsy

Myocardial arrhythmia

ECG confirmed, with hypotension or symptomatic angina, necessitating stabilizing drugs or electro-conversion

Cardiac arrest

Confirmed by ECG or cardiac rhythm monitoring, and necessitating resuscitation

Acute Cardiac failure

Confirmed by by Echocardiosonography or necessitating pressure agents

Cerebrovascular infarction or cerebrovascular haemorrhage

New, and persistent (>48 h) central neurological deficit, and confirmed by CT scan or demonstrated upon autopsy

Pulmonary embolism

Confirmed by unequivocal nuclear isotope scan, ECG, pulmonary angiography, spiral technique CT scan or demonstrated upon autopsy

Pulmonary insufficiency

Necessitating postoperative ventilation support more than 24 h