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How to report complications in surgery: the Clavien-Dindo classification
Posted in Lectures on 16 April 2019

F. Borja de Lacy
Gastrointestinal Surgery Specialist
Hospital Clinic de Barcelona, Barcelona, Spain

Quality assessment in surgery needs to be clear and standardized to avoid confusion. One of the main endpoints in surgical quality assessment is the evaluation of post-surgical complications. In 1992, a new classification system was proposed to grade the severity of complications based on the therapy required. In 2004, the same group revised the original classification and described the Clavien-Dindo classification, which is based on 5 (+2) grades. The Clavien-Dindo classification has been shown to be understandable, simple, objective and reproducible, and enjoyed a wide implementation into clinical practice.

There are some controversial issues, such as whether all complications need to be recorded or only the most severe ones. The consensus has been to register only the most severe events, when they are clearly related to each other. On the other hand, in cases of unrelated events, all complications should be listed.

A more novel aspect has been the development of the Comprehensive Complication Index (CCI). This was recently introduced to avoid the common fact that physicians only reported the most severe complication or only the event that they judged to be important, ignoring unrelated complications of lesser magnitude. Therefore, if only the most severe complication is recorded, the rest of events and the total number of complications are ignored, even though they affect the patient. The CCI, based on complications graded in the Clavien-Dindo classification, is a reflection of the entire postoperative experience and seems to be superior to traditional morbidity endpoints. All these relevant issues, which are found in everyday practice, will be addressed in this video.