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Table 1 A priori definition of postoperative complications

From: Perioperative hemodynamic optimization using the photoplethysmography in colorectal surgery (the PANEX3 trial): study protocol for a randomized controlled trial

Complication Definition
Paralytic ileus Failure to tolerate solid food or defecate for 3 or more days after surgery
Infection, source uncertain Strong clinical suspicion of infection, but the source has not been confirmed because clinical information suggests more than one possible site, meeting two or more of the following criteria: core temperature < 36 °C or > 38 °C, white cell count > 12 x 109/l or < 4 x 109/l, respiratory rate > 20 breath/minute or PaCO2 < 4.7 kPa, pulse rate > 90/min.
Surgical site infection (superficial) Infection occurs within 30 days after surgery and involves only skin and subcutaneous tissue of the incision and (purulent drainage from superficial incision, organisms isolated from superficial surgical site, or diagnosis of incisional surgical site infection by a surgeon or attending physician, or clinical symptoms in this surgical superficial site.
Surgical site infection (deep) Infection occurs within 30 days after surgery and involves deep soft tissues and purulent drainage, or abscess or other evidence of infection during surgery or radiological examination, or a deep incision spontaneously dehisces or is deliberately opened by a surgeon and its culture is positive or the patient is symptomatic.
Surgical site infection (organ/space) Infection that involves any part of the body, excluding the fascia or muscle layers, and meets the criteria further indicated. Infection occurs within 30 days after surgery, and the infection appears to be related to the surgical procedure and involves any part of the body, excluding the skin incision, fascia or muscle layers opened or manipulated during the operative procedure, and the patient has at least one of the following criteria: purulent drainage from a drain that is placed through a stab wound into the organ/space; or organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space; or an abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathological or radiological examination; or diagnosis of an organ/space surgical site infection by a surgeon or attending physician).
Laboratory-confirmed bloodstream infection Patient has a recognized pathogen cultured from one or more blood cultures, and the organism cultured from the blood is not related to an infection at another site, or the patient had clinical signs (fever > 38 °C, hypotension, or chills) and at least one of the following common skin contaminants cultured from two or more blood cultures drawn on separate occasions, or one blood culture from a patient with an intravascular line, and the physician institutes appropriate antimicrobial therapy, or positive blood antigen test.
Anastomotic breakdown Leak of luminal contents from a surgical connection between two hollow viscera. The luminal contents may emerge either through the wound or at the drain site, or they may collect near the anastomosis, causing fever, abscess, septicemia, metabolic disturbance, and/or multiple organ failure.
Postoperative hemorrhage Blood loss within 72 h after surgery, which requires a transfusion of blood
Gastrointestinal bleed Gastrointestinal bleed is defined as unambiguous clinical or endoscopic evidence of blood in the gastrointestinal tract. Upper gastrointestinal bleeding (or hemorrhage) is that originating proximal to the ligament of Treitz, in practice from the esophagus, stomach, and duodenum. Lower gastrointestinal bleeding is that originating from the small bowel or colon.
Urinary tract infection Positive urine culture of ≥105 colony forming units/ml with no more than two species of microorganisms, and with at least one sign (among fever > 38 °C, dysuria, suprapubic tenderness, costovertebral angle pain, or tenderness with no other recognized cause.
Acute kidney injury 1.5 times baseline value within 7 days.
Respiratory failure Postoperative PaO2 < 8 kPa (60 mm Hg) on room air, a PaO2:FI02 ratio < 40 kPa (300 mmHg) or arterial oxyhemoglobin saturation measured with pulse oximetry < 90 % and requiring oxygen therapy.
Pneumonia New or progressive and persistent infiltrates or consolidation or cavitation in at least one chest radiograph, with at least one (among fever > 38 °C, white cell count > 12 x 109/l or < 4 x 109/l, altered mental status with no other recognized cause for adults > 70 years old), and at least two (among new onset or change in character in sputum, new onset or worsening cough or dyspnea or tachypnea, rales breath sounds, or worsening gas exchange).
Pulmonary embolism Pulmonary embolism confirmed by cardiothoracic angiography in the postoperative period.
Acute respiratory distress syndrome New worsening respiratory symptoms, bilateral opacities in chest imaging, without cardiac failure, and PaO2/FiO2 < 300 mm Hg.
Cardiogenic pulmonary edema Evidence of fluid accumulation in the alveoli due to poor cardiac function.
Myocardial infarction Increase in troponin Ic, with at least one value above the 99th percentile (≥0.04 ng/ml) upper reference limit, and at least one the following criteria: ST or T wave ECG changes or new left bundle branch block, development of pathological Q waves on ECG, echocardiographic evidence of new loss of viable myocardium or new regional wall motion abnormality, or identification of an intracoronary thrombus at angiography.
Myocardial injury Peak troponin Ic ≥ 0.04 ng/ml (99th percentile).
Arrhythmia Evidence of cardiac rhythm disturbance in electrocardiograph.
Cardiac arrest Cessation of cardiac mechanical activity, as confirmed by the absence of signs of circulation.
Stroke Embolic, thrombotic, or hemorrhagic cerebral event, with persistent residual motor, sensory, or cognitive dysfunction.