Application of the Clavien-Dindo classification to a pediatric surgical network

Thompson, Hannah; Jones, Ceri; Pardy, Caroline; Kufeji, Dorothy; Nichols, Eric; Murphy, F Y; Davenport, Mark

doi:10.1016/j.jpedsurg.2019.10.032

Cited by 38 publications

(22 citation statements)

References 24 publications

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“…While many other studies have reported only the most common complications (i.e., SSI, IAA, ileus, and postoperative pyrexia) (14,15), we reported complications of any kind that required a form of treatment. To evaluate the severity of the complications, we used Clavien-Dindo classification, which is the most commonly used system for categorizing the severity of complications (16,17). The use of standardized reporting for the type of appendicitis (simple or complex) and complications, including explicit definitions for these complications and their severity, are key factors in improving the comparability of future studies.…”

Section: Discussionmentioning

confidence: 99%

Complications after appendectomy in patients with treated appendicitis: results from a retrospective study

Wu¹,

Yang²,

Wu³

et al. 2021

Ann Palliat Med

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Background: This study was designed to provide additional insights into the incidence of appendectomy complications in patients with appendicitis.Methods: A total of 619 patients who underwent appendectomy for appendicitis between 2014 and 2020 were recruited. Preoperative patient data and details of postoperative complications were collected.Comparisons between simple and complex appendicitis were obtained via univariate and multivariate analyses of the outcomes.Results: Simple and complex appendicitis was diagnosed in 192 and 427 patients, respectively. Twentyeight patients with simple appendicitis developed complications, and 14 of these were infectious complications. In patients with complex appendicitis, 65 patients developed complications, and 55 of these were infectious complications. Infectious complications were identified as the largest proportion of complications. The significant risk factor for infectious complications in simple appendicitis was American Society of Anesthesiologists (ASA) grade [odds ratio (OR) =7.843, 95% confidence interval (CI): 1.987-30.955, P=0.003]. ASA grade (OR =1.992, P=0.032) and positive bacterial culture (OR =4.019, 95% CI:1.809-8.933, P=0.001) were significantly related to infectious complication in complex appendicitis.Conclusions: This study showed that appendectomy is not always a routine operation with few complications. There was a relatively high rate of complications in patients with appendicitis, which were mostly infectious complications. A higher ASA grade correlated with infectious complication. In some cases of complex appendicitis, patients with positive bacterial culture may have had a greater risk of infectious complications.

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Section: Discussionmentioning

confidence: 99%

Complications after appendectomy in patients with treated appendicitis: results from a retrospective study

Wu¹,

Yang²,

Wu³

et al. 2021

Ann Palliat Med

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“…Grade III complications were divided into IIIa and IIIB according to general anesthesia, and grade IV complications were divided into IVA and IVB according to the number of organs involved. The Claviden–Dindo complications classification system has been proven to have good clinical application value in urology, pediatrics, and head and neck surgery 10–12 . However, it is worth noting that the grading system does not systematically grade the complications of thoracic surgery as the relevant grading is not detailed enough, and lacks the definition and grading standard widely accepted by thoracic surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…The Claviden–Dindo complications classification system has been proven to have good clinical application value in urology, pediatrics, and head and neck surgery. 10 , 11 , 12 However, it is worth noting that the grading system does not systematically grade the complications of thoracic surgery as the relevant grading is not detailed enough, and lacks the definition and grading standard widely accepted by thoracic surgeons. Hence, it is easy to produce deviation in the application of thoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

Escalated grades of complications correlate with incremental costs of video‐assisted thoracoscopic surgery major lung resection for lung cancer in China

et al. 2021

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Objective Few studies have focused on factors associated with the incremental cost of video‐assisted thoracoscopic surgery (VATS) in China. We aim to systematically classify the complications after VATS major lung resection and explore their correlation with hospital costs. Methods Patients with pathologically stage I–III lung cancer who underwent VATS major lung resections from January 2007 to December 2018 were included. The Thoracic Mortality and Morbidity (TM&M) Classification system was used to evaluate postoperative complications. Grade I and II complications, defined as minor complications, require no therapy or pharmacologic intervention only. Grade III and IV complications, defined as major complications, require surgical intervention or life support. Grade V results in death. A generalized linear model was used to explore the correlation of incremental hospital costs and complications, as well as other clinicopathologic parameters between 2013 and 2016. Results A total of 2881 patients were enrolled in the first part, and the minor and major complications rates were 24.3% (703 patients) and 8.3% (228 patients), respectively. Six hundred and eighty‐two patients were enrolled in the second part. The complications grade II (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.05–1.2, p = 0.0005), grade III (OR 1.55, 95% CI 1.26–1.9, p < 0.0001), grades IV and V (OR 1.09, 95% CI 1.04–1.13, p = 0.0002), diffusion capacity of carbon dioxide (OR 0.998, 95% CI 0.997–1.000, p = 0.004), and duration of chest drainage (OR 1.03, 95% CI 1.02–1.04, p < 0.001) and were independent risk factors for the increase in in‐hospital costs of VATS major lung resections. Conclusions The severity of complications graded by the TM&M system was an independent risk factor for increased in‐hospital costs.

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“…In 1992, Clavien proposed a stratification of complication severity. This classification was subsequently improved by Dindo, giving rise to the Clavien-Dindo classification in 2004 (6,9,10) .…”

Section: Introductionmentioning

confidence: 99%

“…In pediatrics, there are few standard criteria allowing postoperative complications to be classified and consolidated (5,9,10) , particularly in appendectomy (13) , where according to the literature, complications range from 5% to 30% (14) . Complication risk increases with disease severity (15) .…”

Section: Introductionmentioning

confidence: 99%

Clavien-Dindo classificationa: a tool to assess complications following surgical treatment in children with acute appendicitis

Estrada¹,

Pérez²,

Pascual³

et al. 2022

Cir Pediatr

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Introduction. In pediatrics, there are few standard criteria to classify and consolidate postoperative complications, particularly in appendectomy, where according to the literature, complications range from 5% to 30%.Methods. A cross-sectional, observational, retrospective study of patients undergoing surgery as a result of suspected acute appendicitis (AA) from December 2018 to January 2020 was carried out. Complications were grouped and consolidated according to the Clavien-Dindo (CD) classification. Postoperative complications and factors involved were analyzed by conducting a bivariate and multivariate statistical study using SPSS statistical software, version 25.Results. A total of 124 patients were studied. Mean age was 9 years (3-14 years). 62% were boys, and 38% were girls. All patients underwent appendectomy -80.6% through laparotomy, and 19.4% through laparoscopy. 20% of patients had postoperative complications, which were grouped according to the CD classification (p = 0.002). Most complications were included in the CD I group (64%). Collections treated with antibiotic therapy were included in the CD II group (28%). Intra-abdominal collections requiring re-intervention for drainage purposes were included in the CD IIIb group (8%). The main factors driving complications were complicated AA (81% gangrenous and perforated) (p < 0.001) and progression time (80% >24 h of progression) (p = 0.036), which increased mean hospital stay by 7 ± 4 days (p = 0.016). 137 ± 37 CRP levels were associated with plastron identification (p < 0.001), whereas 109 ± 19 CRP levels were associated with peritonitis (p < 0.001).Conclusions. The Clavien-Dindo classification allows post-appendectomy complications in pediatric surgery to be classified using a common language, by associating complication grade with treatment complexity.

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Application of the Clavien-Dindo classification to a pediatric surgical network

Cited by 38 publications

References 24 publications

Complications after appendectomy in patients with treated appendicitis: results from a retrospective study

Complications after appendectomy in patients with treated appendicitis: results from a retrospective study

Escalated grades of complications correlate with incremental costs of video‐assisted thoracoscopic surgery major lung resection for lung cancer in China

Clavien-Dindo classificationa: a tool to assess complications following surgical treatment in children with acute appendicitis

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