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Complications—A New Open-Access Journal for Improving Our Understanding of Prevention and Management of Surgical, Interventional and Anesthesiologic Complications and Adverse Events

Giovanni E. Cacciamani
Institute of Urology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
Complications 2024, 1(1), 1-5;
Submission received: 21 December 2022 / Accepted: 22 December 2022 / Published: 31 December 2022


The reporting of surgical, interventional, and anesthesiologic complications is essential for improving the quality of healthcare delivery and for standardizing and reproducing outcomes data. To address underlying issues in the reporting of complications and adverse events, it may be necessary to provide education and training, establish standardized definitions and reporting requirements, and create incentives for healthcare providers to report complications. Complications, a new international peer-reviewed open access journal, aims to provide best practice and expert opinion recommendations on the prevention, diagnosis, pathogenesis, and management of complications in basic, translational, and clinical research, as well as epidemiology. The journal invites authors to address four components of perioperative adverse events: assessment, reporting, analysis of anticipatable factors, and management. The usability and practical implications of this information can have significant implications for academic and clinical practice. The prioritization of the assessment and reporting of adverse events to standardize their management and improve the understanding of the impact of these events on patients’ peri-operative course.

Negative outcomes in medical research, such as adverse events, are vital for a comprehensive understanding of treatment effectiveness [1]. Identifying these outcomes is key to pinpointing potential safety issues and areas for enhancement, which are critical for patient care [2].
This commitment to patient safety and quality improvement is significant for maintaining the integrity of the medical profession and fostering trust in the healthcare system [3,4,5,6,7,8,9,10,11,12,13,14]. These practices are underpinned by the principle of nonmaleficence, which requires prioritizing patient well-being and minimizing risks [15].
Complications and adverse events need to be reinterpreted; they should cease to be seen as a stigma. Recognizing them as physiological and an integral part of the learning process, particularly in surgical fields [15,16], can shift perspectives and improve practice.
A recent surge in publications regarding complications and adverse events may be attributed to an increasing emphasis on patient safety, as well as technological advancements and standardization of criteria for collecting, grading, and reporting these events. This standardization facilitates the study of complications and pattern identification (Figure 1).
However, standardizing the collection, grading, and reporting of complications comes with challenges [17,18,19,20,21,22,23,24,25,26]. Factors contributing to this include lack of awareness, time constraints, fear of liability, absence of standardized definitions, and lack of incentives [16].
To address these challenges, it is crucial to encourage education and training on reporting, standardize definitions and requirements, establish incentives, and create a peer-reviewed resource for this information.
Complications (ISSN 2813-4966) [27] is an international, peer-reviewed, open-access journal that focuses on the prevention, diagnosis, etiology, and management of complications in all aspects of basic, translational, and clinical research, as well as epidemiology. The journal seeks to offer best practices and expert experience, and recommendations on intra-operative and post-operative adverse events.
Given the rising demand and cost of healthcare, the efficacy of its delivery is a central concern for policymakers. Quality metrics, often based on standardized and replicable outcome data, serve as key gauges of this efficacy. These metrics influence hospital training, profit margins, and insurance payouts, thereby shaping healthcare cost and quality. To address this, the journal Complications offers expert guidance on managing intra-operative and post-operative adverse events.
Authors are urged to explore four aspects of perioperative adverse events: assessment, grading, reporting, analysis of anticipatory factors (including patient, disease, and surgical features), and management. The practical relevance of this information, which could significantly impact academia and clinical practice, is highly valued.
To enhance quality and training, editors and reviewers should recommend Adverse events outcome reporting and documentation. Choosing the correct reporting tool is crucial to avoid data inaccuracies, and focus on evaluating and documenting adverse events is needed to standardize management and understand these events’ true impact on patients’ perioperative trajectory.


This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Shadish, W.R.; Cook, T.D.; Campbell, D.T. Experimental and Quasi-Experimental Designs for Generalized Causal Inference; Houghton, Mifflin and Company: Boston, MA, USA, 2002. [Google Scholar]
  2. Altman, D.G.; Simera, I. Using Reporting Guidelines Effectively to Ensure Good Reporting of Health Research. In Guidelines for Reporting Health Research: A User’s Manual; Wiley: Hoboken, NJ, USA, 2014; pp. 32–40. [Google Scholar]
  3. Cacciamani, G.E. Intraoperative adverse events grading tools and their role in honest and accurate reporting of surgical outcomes. Surgery 2022, 172, 1035–1036. [Google Scholar] [CrossRef] [PubMed]
  4. Artibani, W. What you measure depends on the tool you use: A short step from incorrect measurements to fake data. Eur. Urol. 2018, 74, 8–9. [Google Scholar] [CrossRef] [PubMed]
  5. Clavien, P.A.; Sanabria, J.R.; Strasberg, S.M. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992, 111, 518–526. [Google Scholar] [PubMed]
  6. Clavien, P.A.; Strasberg, S.M. Severity grading of surgical complications. Ann. Surg. 2009, 250, 197–198. [Google Scholar] [CrossRef]
  7. Dindo, D.; Demartines, N.; Clavien, P.-A. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004, 240, 205–213. [Google Scholar] [CrossRef]
  8. Satava, R. The nature of surgical error A cautionary tale and a call to reason. Surgical endoscopy and other interventional techniques. Surg. Endosc. 2005, 19, 1014–1016. [Google Scholar] [CrossRef]
  9. Biyani, C.S.; Pecanka, J.; Rouprêt, M.; Jensen, J.B.; Mitropoulos, D. Intraoperative adverse incident classification (EAUiaiC) by the European Association of Urology ad hoc complications guidelines panel. Eur. Urol. 2020, 77, 601–610. [Google Scholar] [CrossRef]
  10. Dell-Kuster, S.; Gomes, N.V.; Gawria, L.; Aghlmandi, S.; Aduse-Poku, M.; Bissett, I.; Blanc, C.; Brandt, C.; Ten Broek, R.B.; Bruppacher, H.R.; et al. Prospective validation of classification of intraoperative adverse events (ClassIntra): International, multicentre cohort study. BMJ 2020, 370, m2917. [Google Scholar] [CrossRef]
  11. Francis, N.; Curtis, N.; Conti, J.; Foster, J.; Bonjer, H.; Hanna, G. EAES classification of intraoperative adverse events in laparoscopic surgery. Surg. Endosc. 2018, 32, 3822–3829. [Google Scholar] [CrossRef] [PubMed]
  12. Jung, J.J.; Jüni, P.; Gee, D.W.; Zak, Y.; Cheverie, J.; Yoo, J.S.; Morton, J.M.; Grantcharov, T. Development and evaluation of a novel instrument to measure severity of intraoperative events using video data. Ann. Surg. 2020, 272, 220–226. [Google Scholar] [CrossRef] [PubMed]
  13. Kaafarani, H.M.; Mavros, M.N.; Hwabejire, J.; Fagenholz, P.; Yeh, D.D.; Demoya, M.; King, D.R.; Alam, H.B.; Chang, Y.; Hutter, M.; et al. Derivation and validation of a novel severity classification for intraoperative adverse events. J. Am. Coll. Surg. 2014, 218, 1120–1128. [Google Scholar] [CrossRef]
  14. Kazaryan, A.M.; Røsok, B.I.; Edwin, B. Morbidity assessment in surgery: Refinement proposal based on a concept of perioperative adverse events. Int. Sch. Res. Not. 2013, 2013, 625093. [Google Scholar] [CrossRef] [PubMed]
  15. Beauchamp, T.L.; Childress, J.F. Principles of Biomedical Ethics; Edicoes Loyola: São Paulo, Brazil, 1994. [Google Scholar]
  16. Han, K.; Bohnen, J.D.; Peponis, T.; Martinez, M.; Nandan, A.; Yeh, D.D.; Lee, J.; Demoya, M.; Velmahos, G.; Kaafarani, H.M. The surgeon as the second victim? Results of the Boston Intraoperative Adverse Events Surgeons’ Attitude (BISA) study. J. Am. Coll. Surg. 2017, 224, 1048–1056. [Google Scholar] [CrossRef]
  17. Cacciamani, G.E.; Sholklapper, T.; Dell’Oglio, P.; Rocco, B.; Annino, F.; Antonelli, A.; Amenta, M.; Borghesi, M.; Bove, P.; Bozzini, G.; et al. The Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) global surgical collaboration project: Development of criteria for reporting adverse events during surgical procedures and evaluating their impact on the postoperative course. Eur. Urol. Focus 2022, 8, 1847–1858. [Google Scholar] [PubMed]
  18. Cacciamani, G.; Sholklapper, T.; Sotelo, R.; Desai, M.; Gill, I. A protocol for the development of the intraoperative complications assessment and reporting with universal standards criteria: The ICARUS Project. Int. J. Surg. Protoc. 2021, 25, 160. [Google Scholar] [CrossRef]
  19. Eppler, M.; Sayegh, A.S.; Goldenberg, M.; Sholklapper, T.; Hemal, S.; Cacciamani, G.E. If You Know Them, You Avoid Them: The Imperative Need to Improve the Narrative Regarding Perioperative Adverse Events. J. Clin. Med. 2022, 11, 4978. [Google Scholar] [CrossRef] [PubMed]
  20. Cacciamani, G.E.; Medina, L.G.; Tafuri, A.; Gill, T.; Baccaglini, W.; Blasic, V.; Glina, F.P.; Abreu, A.L.D.C.; Sotelo, R.; Gill, I.S.; et al. Impact of implementation of standardized criteria in the assessment of complication reporting after robotic partial nephrectomy: A systematic review. Eur. Urol. Focus 2020, 6, 513–517. [Google Scholar] [CrossRef] [PubMed]
  21. Cacciamani, G.E.; Maas, M.; Nassiri, N.; Ortega, D.; Gill, K.; Dell’Oglio, P.; Thalmann, G.N.; Heidenreich, A.; Eastham, J.A.; Evans, C.P.; et al. Impact of pelvic lymph node dissection and its extent on perioperative morbidity in patients undergoing radical prostatectomy for prostate cancer: A comprehensive systematic review and meta-analysis. Eur. Urol. Oncol. 2021, 4, 134–149. [Google Scholar] [CrossRef]
  22. Cacciamani, G.E.; Tafuri, A.; Iwata, A.; Iwata, T.; Medina, L.; Gill, K.; Nassiri, N.; Yip, W.; de Castro Abreu, A.; Gill, I. Quality assessment of intraoperative adverse event reporting during 29,227 robotic partial nephrectomies: A systematic review and cumulative analysis. Eur. Urol. Oncol. 2020, 3, 780–783. [Google Scholar] [CrossRef]
  23. Cacciamani, G.E.; Sholklapper, T.; Dell-Kuster, S.; Biyani, S.C.; Francis, N.; Kaafarani, H.M.; Desai, M.; Gill, I.; ICARUS Global Surgical Collaboration. Standardizing The Intraoperative Adverse Events Assessment to Create a Positive Culture of Reporting Errors in Surgery and Anesthesiology. Ann. Surg. 2022, 276, e75–e76. [Google Scholar] [CrossRef]
  24. Sayegh, A.S.; Eppler, M.; Ballon, J.; Hemal, S.; Goldenberg, M.; Sotelo, R.; Cacciamani, G.E. Strategies for Improving the Standardization of Perioperative Adverse Events in Surgery and Anesthesiology: “The Long Road from Assessment to Collection, Grading and Reporting”. J. Clin. Med. 2022, 11, 5115. [Google Scholar] [CrossRef] [PubMed]
  25. Martin, R.C.; Brennan, M.F.; Jaques, D.P. Quality of complication reporting in the surgical literature. Ann. Surg. 2002, 235, 803. [Google Scholar] [CrossRef] [PubMed]
  26. Mitropoulos, D.; Artibani, W.; Graefen, M.; Remzi, M.; Rouprêt, M.; Truss, M. Reporting and grading of complications after urologic surgical procedures: An ad hoc EAU guidelines panel assessment and recommendations. Eur. Urol. 2012, 61, 341–349. [Google Scholar] [CrossRef] [PubMed]
  27. Complications Home Page. Available online: (accessed on 20 December 2022).
Figure 1. Trends over time of publications on Complications and Adverse Events from Web of Science (Access 20 December 2022).
Figure 1. Trends over time of publications on Complications and Adverse Events from Web of Science (Access 20 December 2022).
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Short Biography of Author

Dr. Giovanni E. Cacciamani is a urologic surgeon and surgeon-scientist who is an assistant professor of urology and radiology at the Department of Urology at the University of Southern California (USC) and the co-director of the Artificial Intelligence Center for Surgical and Clinical Application in Urology Dr. Cacciamani earned his medical degree and master of science in medicine and surgery from the University of Verona. He completed a urology residency at the “Confortini” Hospital at the University of Verona, and a minimally invasive surgery research fellowship at USC. Dr. Cacciamani’s main areas of interest are translational research on complications assessment and patient safety, and the use of artificial intelligence in healthcare, with a particular focus on using machine learning to identify radiomics features that can predict pathology from imaging, use of AI for improving surgical performance and detect predictors of recurrence. He is also the vice-chair of the Research Council at the Department of Urology at USC. Dr. Cacciamani has received several international competitive grants and is the chair and head-lab of the Intraoperative Complication Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration, a cross-specialty, multi-institution initiative that aims to improve the assessment, collection, grading, and reporting of intraoperative adverse events with the ultimate goal of improving patient safety. He has published 250 articles in international peer-reviewed journals, several Prospero Protocols from the University of York, 15 book chapters, and more than 200 abstracts at national and international meetings. In July 2020, he received the 10-year National Scientific Qualification for associate professorship (clinical and research from the Italian Ministry of University and Research. In 2021, Cacciamani received the “Matula Award 2021” for the best Italian urologist under 40 and was named “Citizen of the Year 2021” in Verona in the healthcare category. Cacciamani is a member of 11 professional societies in the urological field and is the chairman of the Young Academic Urology Working Party of the European Association of Urology in Uro-Technology (2021-present). He is also a board member of the European Association of Urology Research Foundation and the European Society of urologic Technology. In 2021, Dr. Cacciamani was appointed as the editor-in-chief of Complications.
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MDPI and ACS Style

Cacciamani, G.E. Complications—A New Open-Access Journal for Improving Our Understanding of Prevention and Management of Surgical, Interventional and Anesthesiologic Complications and Adverse Events. Complications 2024, 1, 1-5.

AMA Style

Cacciamani GE. Complications—A New Open-Access Journal for Improving Our Understanding of Prevention and Management of Surgical, Interventional and Anesthesiologic Complications and Adverse Events. Complications. 2024; 1(1):1-5.

Chicago/Turabian Style

Cacciamani, Giovanni E. 2024. "Complications—A New Open-Access Journal for Improving Our Understanding of Prevention and Management of Surgical, Interventional and Anesthesiologic Complications and Adverse Events" Complications 1, no. 1: 1-5.

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