A study on assessment of postoperative complications among major abdominal surgeries using Clavien-Dindo classification
Keywords:Clavien-Dindo score, Major abdominal surgeries, Post-operative risk assessment
Background: Surgical team always tries to provide consistently low incidence of major complications for patient undergoing any operation. Clavien-Dindo (CD) classification is the simplest way of reporting all complications. The main aim of this study was to test the usefulness of Clavien-Dindo classification in patients undergoing the abdominal surgery. In this study Clavien-Dindo classification has been used for assessment of postsurgical complications after major abdominal surgery.
Methods: A total of 50 patients admitted to surgical wards for major abdominal surgery were evaluated through history, co-morbid condition and thorough clinical examination based on inclusion and exclusion criteria along with necessary investigations. Post-operative complications and management were recorded, and then postsurgical complication was classified based on Clavien-Dindo classification and assessed.
Results: Most of the patients who developed complications were in the age group of 40-50 years. Most of the patients (32%) belonged to grade 2 complications. Serum creatinine, blood urea and post-operative stay were found to have direct relation with Clavien-Dindo grade of complications.
Conclusions: The Clavien-Dindo classification represents an objective and simple way of reporting all complications in patients undergoing major abdominal surgeries and comparing the various complications between different surgeries. However, a definite statement on the clinical value of this classification system is not yet possible due to the small case number in this study, but the promising results should encourage further evaluation in larger cohort with the goal to possibly establish its validity as a standard clinical practice.
Clavein PA, Sanabria JR, Strasberg SM. Proposed classification of complication surgery with examples of utility in cholecyctectomy. Surgery. 1992;111:518-26.
Vignesh R, Raza M. Assessment of postoperative complications in elective major abdominal surgeries by clavein-dindo classification system in the Indian hospital setting. Paripex Indian J Res. 2016;5:6-10.
Pierre AC, Jeffrey B, Michelle LO, Jean NV, Daniel D, Richard DS, et al. The Clavein-Dindo Classification of surgical complication: Five year experience. Ann Surg. 2009;250:187-95.
Riccardo C, Claudio R, Raffaele P, Lucia C, Marielda D, Giovanni T, et. al. Assessment of complications according to the Clavien-Dindo classification after distal pancreatectomy. J Pancreas. 2011;12(2):125-30.
Pillai S, van Rij A, Williams S, Thomson IA, Putterill MJ, Greig S. Complexity- and risk-adjusted model for measuring surgical outcome. Br J Surg. 1999;86:1567–72.
Jiang X, Hiki N, Nunobe S, Tetsu F, Koshi K, Kyoko N, et al. Postoperative outcomes and complications after laparoscopy-assisted pylorus preserving gastrectomy for early gastric cancer. Ann Surg. 2011;253:928-33.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638-52.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: new proposal with evaluation in cohort of 6336 patients and results of survey. Ann Surg. 2004;240:205-13.
Nadey SH, Papalois VE. Surgical complications: diagnosis and treatment. 1st edn. London: Imperial College Press; 2007: 2-31.
Feldman L, Barkun J, Barkun A, Sampalis J, Rosenberg L. Measuring postoperative complications in general surgery patients using an outcome based strategy: comparison with complications presented at morbidity and mortality rounds. Surgery. 1997;122(4):711-9.
Maurits RV, Jan WHLPL, Jerard WK, Breslau PJ. Recording and classification of complications in a surgical practice. Eur J Surg. 1999;165:421-4,5.
Zhou J, Yu P, Shi Y, Tang B, Hao Y, Zhao Y, et al. Evaluation of Clavien–Dindo classification in patients undergoing total gastrectomy for gastric cancer. Med Oncol. 2015;32(4):120.
Seymour IS. A focused history of surgery. Michael JZ, Stanley WA. Maingot’s Abdominal Operations 12th edn. New York: McGraw Hill Medical; 2013: 3-4.
Kenneth F. Metabolic response to injury. In: Norman SW, Roanan OP, Andrew WM, eds. Bailey and Love’s Short practice of surgery. 27th edn. Florida: CRC Press; 2018: 5-11.
Clavien PA, Dindo D. Surgeon’s intuition: is it enough to assess patients’ surgical risk? World J Surg. 2007;31:1909-11.
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668-85.
Lebeau R, Traoré M, Anzoua KI. Prognostic factors of postoperative morbidity and mortality of adult strangulated groin hernia. Indian J Surg. 2016;78(3):192-6.
Jeniffer ER. Postoperative Care. In: Gerard MD, ed. Current Diagnosis and Treatment in Surgery. 14th edn. New York: McGraw Hill Education; 2015: 34-44.
Mentula PJ, Leppaniemi AK. Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients. Patient Safety Surg. 2014;8:31:1-7.
Targarona EM, Espert JJ, Bombuy E, Oscar V, Gemma C, Cicente A, et al. Complications of laparoscopic splenectomy. Arch Surg. 2000;135:1137-40.
Moria ED, Joseph TD, Glenn MC, Heidi AS, Francis XS, Michael CO. The Clavien-Dindo classification of surgical complication is not a statistically reliable system for grading morbidity in pediatric urology. J Urol. 2016;195(2):460-4.
Maria W, Paul S, Metin K, Renee LG, Elena E, Martin RW, et al. Burden of surgical complications: Contribution of long term costs by Clavien-Dindo classification. J Am Coll Aurg. 2016;223(4):90.
Wang W, Babu SR, Wang L, Chen Y, Tian B, He H. Use of Clavien Dindo classification in evaluating complications following pancreaticoduodenectomy in 1,056 cases: A retrospective analysis from one single institution. Oncol Letters. 2018;16(2):2023-9.