There is no doubt that surgical complications are essential for benchmarking quality-of-care and can have a significant impact on patients. Furthermore, complications significantly impact our healthcare systems resulting in additional use of resources and increased costs. Thus, when appropriately adjusted for co-morbidities, complications are often surrogate markers of healthcare quality and efficiency. As such, it is critical that complications are accurately captured and recorded.

Complication reporting in surgery has largely been dominated by Clavien-Dindo Classification methodology in the past decade. However, as good as it has been, there are some inconsistencies. Firstly, the system only accounts for the most severe complications whilst ignoring multiple smaller complications that may accumulate in a patient affecting length of stay and outcome. There is also inter-observer variability regarding the status of complications [1, 2].

Hence, the Complication Reporting after minor and major Urological Surgery (CAMUS) collaboration has risen on the back of the excellent work done by the Clavien-Dindo Classification. The CAMUS collaboration (www.camuscollaboration.com) hopes to address inconsistencies and create a novel speciality-specific complication-reporting and grading system that also incorporates intraoperative as well as ultimately patient-reported outcomes [1, 2].

CAMUS is a collaboration whereby over 100 institutions with tens of thousands of cases are already contributing to the resource of cases from which to interrogate and harmonise complication reporting. A data dictionary has already been established and a large Delphi study is underway to determine the best way to report moving forward.

With centralisation [3] of some more complex surgery creeping along at different levels, it is accurate complication reporting such as that provided by CAMUS [1, 2] that will allow smaller centres to keep doing a variety of procedures. With good data collection and accurate complication reporting this will remain one of the few defences against having procedures moved away to larger centres. It is also likely that registries [4] will take a keener interest in complication reporting provided the data are considered accurate and reproducible and that there is a degree of automation to assist in the collection. Patent perspectives [5] will also have to be accounted for in future data collection.

The question is whether State Government Departments and/or Local Area Health Services will “step-up” and assist. Millions of dollars have been spent on Electronic Medical Records (EMRs) that are clearly more set-up for billing and administrative duty than meaningful clinical work or research. Audit functions are lacking (one need only see how time-consuming and stressful audit is each month for junior residents) and the fundamental principle that the computer software should make a clinician’s life easier is hardly ever followed. It appears those that design hospital software are in a similar genre to those who design hospital wards and buildings — they rarely work in that environment to understand it and they certainly never return a year or two later to see if what they did actually works and to learn from their mistakes (only to have them repeated again!).

The chief principle of an EMR should be that mouse clicks are data points and that the setup of software should make workflow easier, quicker and more logical — leading to more accurate records and better reporting and communication. This principle remains elusive no matter how much more the health systems pay for an EMR whilst clinicians suffer under the opposite — workflow is more difficult, slower and less logical leading to less accurate records and poorer reporting and communication.

One can only dream of a future where clinician and other health worker staff is at the centre of an EMR. In the meantime, we need to get our house in order in terms of complication reporting and make certain we can do it to the benefit of our outcomes — CAMUS is a step in the right direction.

Nathan Lawrentschuk is a founding member of CAMUS and involved in its development and data collection.