Evidence map›Paper›PMID 42130329›Full record

ArticleThe journal of trauma and acute care surgery2026

The extended postoperative complication score: A dual-axis reporting plan for general surgery.

Federico Coccolini, Enrico Cicuttin, Mircea Chirica, Viktor Reva, Raul Coimbra, Massimo Sartelli, Arda Isik, Walter L Biffl, Camilla Cremonini, Andrea Colli and 15 more

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Article in The journal of trauma and acute care surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

25 authors.

Federico CoccoliniDepartment of General, Emergency, and Trauma Surgery, Pisa University Hospital, Pisa, Italy (F.C., C.C.); Department of General, Emergency, and Trauma Surgery, Pavia University Hospital, Pavia, Italy (E.C.); Department of General and Emergency Surgery, Grenoble University Hospital, Grenoble, France (M.C.); Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russia (V.R.); Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA (R.C.); Department of General and Emergency Surgery, Macerata Hospital, Macerata, Italy (M.S.); Department of General and Emergency Surgery, Istanbul Medeniyet University, Istanbul, Turkey (A.I.); Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA (W.L.B.); Department of Cardiac Surgery, Pisa University Hospital, Pisa, Italy (A.C., L.B.); Department of General and Emergency Surgery, Legnano Hospital, Legnano, Italy (D.M.); Division of General Surgery, Rambam Health Care Campus, Haifa, Israel (Y.K.); Department of General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy (M.C.); Department of Emergency Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (H.K., M.C.); Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado (E.E.M.); Division of Surgery, Hillel Yaffe Medical Center, Hadera, Israel (B.K.); Department of Cardiothoracic and Vascular Surgery and Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (T.H.); Department of Surgery, Inova Fairfax Hospital, Fairfax County, VA (P.F.); Department of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada (A.W.K.); 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece (M.P.); Department of General, Emergency, and Trauma Surgery, Bufalini Hospital, Cesena, Italy (F.C.); Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, PA (G.B.).ORCID 0000-0001-6364-4186
Enrico Cicuttin
Mircea Chirica
Viktor Reva
Raul Coimbra
Massimo Sartelli
Arda Isik
Walter L Biffl
Camilla Cremonini
Andrea Colli
Laura Besola
Diego Mariani
Yoram Kluger
Marco Ceresoli
Hayato Kurihara
Matteo Cimino
Ernest E Moore
Boris Kessel
Tal Horer
Paula Ferrada
Andrew W Kirkpatrick
Manos Pikoulis
Fausto Catena
Gary Bass
Pisa, Italy

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGrading surgical complications and sequelae is of paramount importance for analyzing results and improving patient care and system performance and in optimizing resource allocation and use. Existing systems for surgical complication classification do not consistently account for baseline physiologic vulnerability and often conflate treatment intensity with clinical severity. This limitation reduces interpretability across diverse patient populations, particularly in emergency and elective general surgery.

methodsA multidisciplinary expert panel conducted a modified Delphi process to develop a dual-axis classification system, the Extended Postoperative Complication Score (EPCS). This system stratifies patients preoperatively into three baseline classes (A, B, C) reflecting physiologic reserve and immunocompetence. Postoperative events are then graded by physiologic impact from Grade 0 (minor, no impact) to Grade IV (death). Sequelae, defined as anticipated events related to underlying pathology or chronic disease, are separately categorized. Representatives of the most relevant international emergency and trauma surgical associations were involved (World Society of Emergency Surgery, European Society for Trauma and Emergency Surgery, American Association for the Surgery of Trauma, Panamerican Trauma Society, EndoVascular and Trauma Management Society, Global Alliance for Infections in Surgery).

resultsThe EPCS yields 18 mutually exclusive strata, combining five complication grades and three baseline classes, plus three sequelae codes. The matrix enables interpretable outcome reporting across settings, accounting for both event severity and host vulnerability. Expert consensus confirmed conceptual clarity and operational feasibility. The system allows applications to elective, urgent, and emergent operations, and is compatible with clinical audit, observational research, and pragmatic trials.

conclusionsThe EPCS provides a structured, physiologically anchored method for postoperative complication stratification. Its dual-axis design may improve the validity of outcome comparisons and support real-world evaluation of surgical quality. Further validation is warranted through prospective multicenter implementation and time-bound observational methodologies. ( J Trauma Acute Care Surg . 2026;100: 324-330. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level V.

Indexed as

General SurgeryPostoperative ComplicationsDelphi TechniqueHumansoutcomespostoperative complicationsregistrySurgery

Identifiers

PMID42130329
PMCPMC13412355

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