294 Chapter 14 databases years ago are now benefitting from these efforts. Examples are the NSQDIP in the United states and the Swedish SPOR. However, a lack of these databases should not cause a lack of attention for attention of these complications. We believe that a pragmatic paradigm shift could result in new insights in these complications which could in turn lead to improvements in the whole field of peri-operative care for young surgical patients. For us, this shift means focusing on complications as a starting point rather than starting off from a cohort of patients with a specific disease. By doing so we might be able to find more general risk factors within diseases which, mostly due to power issues, would not have been found doing the same analysis within patients bound to a specific disease. We agree this goes hand in hand with accepting some form of bias hidden between patients. However, as is the case in life itself too; aside from the differences, there are many similarities between humans. Moreover, we believe that many of the differences within patients can be accounted for by including more general factors, such as gender, age at surgery or type/length of intestine resected during surgery. We do not believe this way to be any better than cohorts focusing on disease specific cohorts. It is just a different way, with its own flaws and strengths. Due to the results provided in part I we asked ourselves how well we performed in the past two decades. In order to be able to evaluate change it is important to know from where you started. Although this might come with unwelcoming surprises, such as higher than expected occurrence of certain complications, it is a perfect way of breaking through ungrounded believes and substantiate where change is necessary. Though the results from such inclusive overall cohorts might be less applicable to answer questions for more specific groups of patients, they do show overall trends and might point out more general focusing points from which a multitude of patients could benefit. We have advocated this general way of evaluating large cohorts at conferences we have visited and we applaud large registries such as the DICA/EPSA in the Netherlands. In the future we aim to re-assess our results of the upcoming decade to see the results of the changes that have come from this thesis. Part III All this lead to Part III, where we set out in to identify incidences and risk factors for postoperative complications within our own cohort of patients treated for abdominal diseases between 1998 and 2018 in the two academic hospitals in Amsterdam (VU and AMC), now fused into the Amsterdam UMC. First, we evaluated the occurrence of central line associated bloodstream infections (CLABSIs) and thrombosis. We found that these infections develop in approximately
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