Surgical morbidity and postoperative complications

Morbidity is graded by the Clavien-Dindo scale and reported alongside mortality; oesophagectomy and pancreaticoduodenectomy have 30-50% complication rates and 2-5% mortality, colectomy far less. Anastomotic leak (where two ends of bowel are joined) is the most feared complication in gastrointestinal surgery and can delay adjuvant chemotherapy or cause death. Complications are reduced by centralisation, minimally invasive approaches, enhanced recovery (ERAS) protocols, prehabilitation and geriatric assessment; 'failure to rescue' (dying from a complication) distinguishes good from poor hospitals more than complication rates do. Ninety-day mortality is now preferred over 30-day because deaths from complications are often later.