CiASE: From Concept to Internationally Celebrated
Following on from our previous article announcing CiASE, we unpack the progress over the past year which has lead to it becoming internationally celebrated.
Prof. Andreas Obermair
4
min read
•
20 Aug 2025
Industry news
Almost a year ago, we posed a question that resonated with many surgeons: “Are all complications equally bad?” The answer, of course, is “no”.
Yet for decades, surgical complication reporting has treated them as if they were. Two events with the same name, let’s say, a bowel injury, could have entirely different implications for the patient’s recovery, long-term wellbeing and the surgeon’s own quality metrics. A serosal tear may be repaired immediately with no lasting consequences; a thermal bowel injury in circumstances of dense fibrotic, mesh adhesions might lead to a prolonged hospital stay and even multiple re-operations. And yet, both would traditionally be recorded the same as “intraoperative bowel injury”.
It was this deficiency that led to the development of CiASE, the “Classification of Intraoperative Adverse Surgical Events”.
Why CiASE?
CiASE was designed to bring nuance, standardisation and patient relevance to how we can report intraoperative events. Instead of viewing complications as a binary “yes/no” occurrence, CiASE grades their severity based on:
1. Clinical impact – what actually happened during and after the operation and what interventions were required.
2. Patient-centred impact – how the event affected recovery, quality of life and long-term outcomes.
This approach allows surgeons to distinguish minor deviations from the ideal course from truly severe complications.
It also opens the door to meaningful benchmarking, because the severity grading creates a common language that works across specialties, procedures, and institutions.
The Past Year: What happened since we published the blog
When we first introduced CiASE in SurgicalPerformance blog last year [“Are all complications equally bad?”], we wanted to start a conversation. And we did. Many of you, SurgicalPerformance users and colleagues from other institutions, made use of CiASE and entered data that could finally capture the real differences between complications.
But the past year has taken CiASE from a simple concept to an internationally validated framework.
We are proud to share that CiASE has now been published in a high-impact, peer-reviewed surgical journal, one of the most respected in the field. This milestone matters for several reasons:
Academic credibility: After rigorous peer-review and expert critique, CiASE has been refined and endorsed by some of the most respected leaders in surgical research globally.
International recognition: Publication in the prestigious International Journal of Gynaecological Cancer gives CiASE visibility and momentum well beyond its early adopters, accelerating the potential for broader adoption.
Standard-setting potential: With this validation, CiASE is well positioned to become a globally recognised standard for severity classification in intraoperative events.
How CiASE Works in Practice
Let’s revisit that example of a bowel injury. In traditional reporting, both cases below would look identical on paper:
Case 1: Small serosal tear during hysterectomy, recognised immediately and repaired with a few interrupted sutures. No postoperative issues, patient discharged as planned.
Case 2: Thermal injury during hysterectomy in the context of mesh adhesions. Patient needs a diverting stoma for a few weeks and then needs to be taken back for a reversal of her stoma.
Under most reporting systems, these are both simply “bowel injuries.” But in reality, the second is a far more severe event for the patient, the surgical team and the institution.
CiASE grades these differently.
The first might be a low-grade intraoperative adverse event (CiASE 1; minor, no long-term effect).
The second would be a high-grade event with significant patient impact for weeks (CiASE 3).
This level of granularity is essential for:
Accurate counting and fair performance benchmarking: Recognising that not all complications carry the same weight.
Meaningful quality improvement: In our own experience we noticed that some reports to our M&M meeting were actually not countable as complications and the majority of complications were only mild. CiASE can help focusing resources where they make the most difference.
Improved patient safety initiatives: Targeting the types of events with the most serious consequences.
Why This Matters for SurgicalPerformance Users
If you’re already a SurgicalPerformance user, CiASE is already built into your reporting framework. That means your complication data is automatically assessed with one of the most rigorously validated classification systems available - now backed by a prestigious international publication.
In other words, you’ve been ahead of the curve.
This integration allows you to:
* Review your complication profile with a severity lens.
* Compare your data with anonymised benchmarks from other surgeons who use CiASE.
* Track whether changes in your technique or protocols are reducing not just the number of complications, but the severity of those that occur.
From Numbers to Meaning
Numbers alone don’t tell the whole story in surgery. Two surgeons could have identical complication rates, but vastly different patient outcomes if one has mostly low-grade events and the other has frequent high-grade events.
By shifting the focus from counting complications to understanding their impact, CiASE makes benchmarking fairer, performance reviews more accurate and quality initiatives more targeted.
It also changes the conversation with patients. Instead of vague statements about complication rates, we can provide a clearer picture:
“In our data, when complications happen, most are low-grade events with minimal impact on recovery.”
That’s a far more meaningful measure of surgical quality.
Looking Ahead
The publication of CiASE in the International Journal of Gynaecological Cancer is certainly not the endpoint. It’s the beginning of a broader movement. We see potential for CiASE to become the gold standard in intraoperative adverse event reporting, adopted not only within SurgicalPerformance but across registries, research studies and institutional quality systems worldwide.
For now, we encourage you to:
1. Revisit your own complication reports in SurgicalPerformance and explore the CiASE grading.
2. Reflect on what the severity distribution says about your practice.
3. Engage with colleagues about how severity-based reporting could improve quality improvement efforts in your institution.
If you missed our original article, you can read it here: “Are all complications equally bad?”.
And for those who want to explore the full academic validation, the peer-reviewed article is available here: doi: 10.1016/j.ijgc.2025.101993.
A complication isn’t just an event — it’s an impact. CiASE makes sure that difference counts.
Almost a year ago, we posed a question that resonated with many surgeons: “Are all complications equally bad?” The answer, of course, is “no”.
Yet for decades, surgical complication reporting has treated them as if they were. Two events with the same name, let’s say, a bowel injury, could have entirely different implications for the patient’s recovery, long-term wellbeing and the surgeon’s own quality metrics. A serosal tear may be repaired immediately with no lasting consequences; a thermal bowel injury in circumstances of dense fibrotic, mesh adhesions might lead to a prolonged hospital stay and even multiple re-operations. And yet, both would traditionally be recorded the same as “intraoperative bowel injury”.
It was this deficiency that led to the development of CiASE, the “Classification of Intraoperative Adverse Surgical Events”.
Why CiASE?
CiASE was designed to bring nuance, standardisation and patient relevance to how we can report intraoperative events. Instead of viewing complications as a binary “yes/no” occurrence, CiASE grades their severity based on:
1. Clinical impact – what actually happened during and after the operation and what interventions were required.
2. Patient-centred impact – how the event affected recovery, quality of life and long-term outcomes.
This approach allows surgeons to distinguish minor deviations from the ideal course from truly severe complications.
It also opens the door to meaningful benchmarking, because the severity grading creates a common language that works across specialties, procedures, and institutions.
The Past Year: What happened since we published the blog
When we first introduced CiASE in SurgicalPerformance blog last year [“Are all complications equally bad?”], we wanted to start a conversation. And we did. Many of you, SurgicalPerformance users and colleagues from other institutions, made use of CiASE and entered data that could finally capture the real differences between complications.
But the past year has taken CiASE from a simple concept to an internationally validated framework.
We are proud to share that CiASE has now been published in a high-impact, peer-reviewed surgical journal, one of the most respected in the field. This milestone matters for several reasons:
Academic credibility: After rigorous peer-review and expert critique, CiASE has been refined and endorsed by some of the most respected leaders in surgical research globally.
International recognition: Publication in the prestigious International Journal of Gynaecological Cancer gives CiASE visibility and momentum well beyond its early adopters, accelerating the potential for broader adoption.
Standard-setting potential: With this validation, CiASE is well positioned to become a globally recognised standard for severity classification in intraoperative events.
How CiASE Works in Practice
Let’s revisit that example of a bowel injury. In traditional reporting, both cases below would look identical on paper:
Case 1: Small serosal tear during hysterectomy, recognised immediately and repaired with a few interrupted sutures. No postoperative issues, patient discharged as planned.
Case 2: Thermal injury during hysterectomy in the context of mesh adhesions. Patient needs a diverting stoma for a few weeks and then needs to be taken back for a reversal of her stoma.
Under most reporting systems, these are both simply “bowel injuries.” But in reality, the second is a far more severe event for the patient, the surgical team and the institution.
CiASE grades these differently.
The first might be a low-grade intraoperative adverse event (CiASE 1; minor, no long-term effect).
The second would be a high-grade event with significant patient impact for weeks (CiASE 3).
This level of granularity is essential for:
Accurate counting and fair performance benchmarking: Recognising that not all complications carry the same weight.
Meaningful quality improvement: In our own experience we noticed that some reports to our M&M meeting were actually not countable as complications and the majority of complications were only mild. CiASE can help focusing resources where they make the most difference.
Improved patient safety initiatives: Targeting the types of events with the most serious consequences.
Why This Matters for SurgicalPerformance Users
If you’re already a SurgicalPerformance user, CiASE is already built into your reporting framework. That means your complication data is automatically assessed with one of the most rigorously validated classification systems available - now backed by a prestigious international publication.
In other words, you’ve been ahead of the curve.
This integration allows you to:
* Review your complication profile with a severity lens.
* Compare your data with anonymised benchmarks from other surgeons who use CiASE.
* Track whether changes in your technique or protocols are reducing not just the number of complications, but the severity of those that occur.
From Numbers to Meaning
Numbers alone don’t tell the whole story in surgery. Two surgeons could have identical complication rates, but vastly different patient outcomes if one has mostly low-grade events and the other has frequent high-grade events.
By shifting the focus from counting complications to understanding their impact, CiASE makes benchmarking fairer, performance reviews more accurate and quality initiatives more targeted.
It also changes the conversation with patients. Instead of vague statements about complication rates, we can provide a clearer picture:
“In our data, when complications happen, most are low-grade events with minimal impact on recovery.”
That’s a far more meaningful measure of surgical quality.
Looking Ahead
The publication of CiASE in the International Journal of Gynaecological Cancer is certainly not the endpoint. It’s the beginning of a broader movement. We see potential for CiASE to become the gold standard in intraoperative adverse event reporting, adopted not only within SurgicalPerformance but across registries, research studies and institutional quality systems worldwide.
For now, we encourage you to:
1. Revisit your own complication reports in SurgicalPerformance and explore the CiASE grading.
2. Reflect on what the severity distribution says about your practice.
3. Engage with colleagues about how severity-based reporting could improve quality improvement efforts in your institution.
If you missed our original article, you can read it here: “Are all complications equally bad?”.
And for those who want to explore the full academic validation, the peer-reviewed article is available here: doi: 10.1016/j.ijgc.2025.101993.
A complication isn’t just an event — it’s an impact. CiASE makes sure that difference counts.
SurgicalPerformance is a confidential online platform, built for surgeons by surgeons, to help you ‘know better’.
SurgicalPerformance is a confidential online platform, built for surgeons by surgeons, to help you ‘know better’.
SurgicalPerformance is a confidential online platform, built for surgeons by surgeons, to help you ‘know better’.