Taxonomy of Complications of Pelvic Floor Surgery

Time

General

Specific

Reoperation

Perioperative

Acute bleeding

Hematoma drainage

Transfusion

Organ injury

Repair organ injury

Pneumonia, atelectasis

Ileus

Arrhythmia, MI, CVA, PE, DVT, death

Postoperative <30 days

MI, CVA, PE, DVT, death

UTI

I&D wound

Incisional pain

Wound infection

Sling revision

Pelvic pain

AUR

PSBO

Leg pain

Storage LUTS

Voiding LUTS

Extrusion

Sling/mesh revision

Erosion into GU tract

Postoperative >30 days

Incisional pain

Storage LUTS

Sling/mesh revision

Pelvic pain

Voiding LUTS

Dyspareunia

Extrusion

Erosion into GU tract

Leg pain

MI myocardial infarction, CVA cerebrovascular accident, PE pulmonary embolism, DVT deep vein thrombosis, UTI urinary tract infection, I&D incision and drainage, AUR acute urinary retention, PSBO partial small bowel obstruction, LUTS lower urinary tract symptoms, GU genitourinary

Table 1.2

Proposed pelvic reconstructive surgery modification of the Clavien system

Grade	Description	Examples
I	Deviation from normal course (no need for additional intervention)	Trocar bladder puncture, replaced; no formal repair
		Perioperative antipyretics
		Postoperative pelvic floor exercises
IIa	Pharmacological intervention (other than for Grade I)	Antibiotics for UTI or wound infection; antimuscarinics
		Transfusion of blood products
		Analgesics for incisional, pelvic, or leg pain
IIb	Short- or long-term complication, no operative intervention	De novo or worsened storage LUTS
		De novo or worsened voiding LUTS
		Incisional, pelvic, or leg pain
III	Operative intervention required
	IIIa: Postoperative, office	Incision and drainage wound infection; partial excision extruded sling/mesh
	IIIb: Intraoperative/immediately postoperative	Repair organ injury (bladder, ureter, colorectal, vascular); endovascular embolization for bleeding
	IIIc: Postoperative, operating room	Sling/mesh incision/revision/excision; urethrolysis; laparotomy for small bowel obstruction; SNM
IV	Life-threatening event
	IVa: Single-organ dysfunction	DVT, PE, MI, CVA/CNS, admission to ICU
	IVb: Multiorgan dysfunction
V	Death

UTI urinary tract infection, LUTS lower urinary tract symptoms, DVT deep vein thrombosis, PE pulmonary embolism, MI myocardial infarction, CVA cerebrovascular accident, CNS central nervous system event, ICU intensive care unit, SNM sacral neuromodulation

Conclusions

A practical taxonomic classification of complications in pelvic reconstructive surgery would be a valuable instrument for reporting outcome measures and quality indicators. While both the modified Clavien and the IUGA/ICS classification systems contain valuable components, at present, a single, comprehensive, user-friendly, and widely accepted system does not exist. The determination of an optimal classification system would lead to an improved ability of surgeons to learn from each other’s experiences and compare and share data.

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