Assessment of Surgical Complications With Respect to the Surgical Indication: Proposal for a Novel Index

Abstract

Introduction: The Clavien–Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them. A drawback of the method is that it does not consider why the patient was operated on primarily.Methods: We designed a novel index based on Clavien–Dindo but with respect to the surgical indication. We surveyed an international panel of otolaryngologists who filled out a questionnaire with 32 real case-inspired scenarios. Each case was graded for the surgical complication, surgical indication, and a subjective rating whether the complication was acceptable or not.Results: Seventy-seven otolaryngologists responded to the survey. Mean subjective rating and surgical complication grading for each scenario showed an inverse correlation (r2 = 0.147, p = 0.044). When grading the surgical complication with respect to the surgical indication, the correlation with the subjective rating increased dramatically (r2 = 0.307, p = 0.0022).Conclusion: We describe a novel index grading surgical complications with respect to the surgical indication. In our survey, most respondents judged a complication as acceptable or not according to its grade but kept in mind the surgical indication. This subjective judgment could be quantified with our novel index.

Mucosal immune cell populations and the bacteriome of adenoids and tonsils from people living with HIV on suppressive antiretroviral therapy

“…Elective surgery was performed for a range of ENT conditions. We used a standardized quality assessment for reporting post-operative complication and found no life-threatening, disabling complications and no postoperative sequelae ( Dindo et al, 2004 ; Gonçalves et al, 2020 ; Morand et al, 2021 ; Kotisalmi et al, 2022 ). A recent report concluded that the risk of surgical complications and postoperative mortality in PLWH with controlled HIV and higher CD4 counts was similar to HIV-uninfected individuals ( Yan et al, 2021 ).…”

“…Elective surgery was performed for a range of ENT conditions. We used a standardized quality assessment for reporting post-operative complication and found no life-threatening, disabling complications and no postoperative sequelae (Dindo et al, 2004;Gonçalves et al, 2020;Morand et al, 2021;Kotisalmi et al, 2022).…”

“…Standardized postoperative care was followed. Surgical complications were classified using the Clavian-Dindo (C-D) guidelines and the indication to complication index ( Dindo et al, 2004 ; Morand et al, 2021 ).…”

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

“…To classify the severity of complications after gastrointestinal surgical procedures, the Clavien–Dindo classification system is commonly used [ 14 ]. This classification consists of five grades in which grades three and four are further subdivided into A and B subgrades, and grade five indicates mortality [ 3 , 14 ].…”

“…To classify the severity of complications after gastrointestinal surgical procedures, the Clavien–Dindo classification system is commonly used [ 14 ]. This classification consists of five grades in which grades three and four are further subdivided into A and B subgrades, and grade five indicates mortality [ 3 , 14 ]. Each grade depends on the required intervention to resolve the complications, the higher the grade is, the more complex the intervention needed [ 3 , 14 ].…”