Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification

Abstract

Introduction: The registration of complications represents an important component in the evaluation of surgical therapeutic procedures. The aim of the present study was to examine the frequency of occurrence as well as the severity of surgical complications after laparoscopic-gynaecological operations in a standardised manner using the Clavien-Dindo system. Material and Methods: Altogether 7438 treatment courses after laparoscopic-gynaecological interventions by 9 working groups were evaluated. Covariates recorded were the technical complexity of the operation, type of study cohort, study size, data acquisition as well as study centre. Target variables recorded were the surgical morbidity rate, subdivided into mild (Clavien-Dindo grade I?II) and severe complications (Clavien-Dindo grade III?V). In addition, a binary logistic regression analysis for the mentioned covariates and the occurrence of surgical complication was carried out. Results: 946 complications were recorded (overall complication rate: 13?%). These included 664 mild complications (8.9?%) and 305 severe complications (4.1?%). A correlation was found between the covariates technical complexity (relative risk [rR] 1.37; p?<?0.01), study size (rR: 0.35; p?<?0.01) and study centre (rR 0.19; p?<?0.01) and the occurrence of surgical complications. Conclusion: By means of a standardised registration of complications using the Clavien-Dindo classification it appears to be possible to limit the methodologically caused underestimation of surgical morbidity in the retrospective evaluation of gynaecological-endoscopic therapeutic procedures. Factors decisively influencing the surgical morbidity of gynaecological-laparoscopic therapeutic procedures are the respective operative experience of the treating facility as well as the technical complexity of the intervention.

Gynaecological Prolapse Surgery in Very Old Female Patients

“…They were recorded retrospectively on the basis of patient records using the Charlson Comorbidity Index [10] and Cumulative Illness Rating Scale Geriatrics (CIRS-G) [11,12] in the diagnosis sheets provided for this purpose [10][11][12][13][14]. A surgical complication was defined as "each and any deviation from the ideal postoperative course which is not inherent to the procedure and excludes failure of the therapy" [17] and systematically classified according to the valid system of Clavien and Dindo (CD) which is recommended by the professional societies [9] and very frequently used in surgical medicine [6,8,14,[18][19][20]. The observation time encompassed the postoperative inpatient stay and a 48-h readmission interval.…”

“…The aim of this retrospective case-control study is to compare the disease courses after surgical prolapse surgery between very elderly patients and a younger control group with a special emphasis on co-morbidities and registration of surgical complications in the postoperative period. For this purpose we employed a standardised, validated registration system, such as the classification of surgical complications according to Clavien-Dindo [6], which is used on large patient collectives in analyses of patient safety in surgical specialties such as gynaecology [7,8], abdominal surgery [6] or urology [9] and is recommended in the guidelines of professional societies [9]. The standardised registration of comorbidities was carried out using the Charlson Comorbidity Index [10] and the Cumulative Illness Rating Scale Geriatrics [11,12], that were evaluated by de Groot et al [13] after an analysis of 13 different methods for recording co-morbidities as valid and reliable instruments for use in clinical research [13].…”

Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien–Dindo classification

“…Several attempts have been made to establish such classification systems for surgical complications [1][2][3][4]. The modified Clavien-Dindo (CD) classification of surgical complications has been widely adopted for safety assessments in surgical procedures [5], including gynecological surgical procedures conducted by our group [6] and others [7], and for procedures in visceral surgery and urology [8]. Briefly, complications are classified according to the need for postoperative medical or surgical interventions [5] in a patient-centred approach.…”

Safety and perioperative morbidity of laparoscopic sacropexy: a systematic analysis and a comparison with laparoscopic hysterectomy

“…One reason for this may be concerns regarding technical severity, since laparoscopic sacropexy is classified as requiring higher operative skills than most other gynecological laparoscopic procedures and thus there are fears of potential complications. [13].…”

“…Laparoscopic sacropexy is classified as a procedure requiring higher operative skills than many other common procedures including laparoscopic hysterectomy [13].…”