Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients.

Panu J Mentula,Ari K Leppäniemi

doi:10.1186/1754-9493-8-31

Abstract

BackgroundPatients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The aim of the current study was to evaluate the Clavien-Dindo classification of surgical complications in emergency surgical patients and to study preoperative factors for risk stratification that should be included into a database of surgical complications.MethodsA cohort of 444 consecutive patients having emergency general surgery during a three-month period was retrospectively analyzed. Surgical complications were classified according to the Clavien-Dindo classification. Preoperative risk factors for complications were studied using logistic regression analysis.ResultsPreoperatively 37 (8.3%) patients had organ dysfunctions. Emergency surgical patients required a new definition for Grade IV complications (organ dysfunctions). Only new onset organ dysfunctions or complications that significantly contributed to worsening of pre-operative organ dysfunctions were classified as grade IV complications. Postoperative complications developed in 115 (25.9%) patients, and 14 (3.2%) patients developed grade IV complication. Charlson comorbidity index, preoperative organ dysfunction and the type of surgery predicted postoperative complications.ConclusionsThe Clavien-Dindo classification of surgical complications can be used in emergency surgical patients but preoperative organ dysfunctions should be taken into account when defining postoperative grade IV complications. For risk stratification patients’ comorbidities, preoperative organ dysfunctions and the type of surgery should be taken into consideration.

Highlights

Patients undergoing emergency surgery have a high risk for surgical complications and death
Organ failures classified as grade IV complications in the Clavien-Dindo classification may be inappropriate for classifying complications of emergency surgical patients, who may already have organ failures preoperatively caused by a severe disease or injury
Preoperative organ dysfunctions were defined as organ specific sequential organ failure assessment (SOFA)-score of 2 or more [9] or if a patient required preoperative intermediate level care (IC) or intensive care unit (ICU) management for organ dysfunction

Summary

Introduction

Patients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The Clavien-Dindo classification was developed and validated using a cohort of general elective surgical patients [2]. Patients undergoing emergency general surgical procedures differ significantly from elective general surgical patients. Emergency surgical patients represent a minority (11%) of all general surgical patients, they are associated with half of mortalities and nearly one third of the complications [7]. Organ failures classified as grade IV complications in the Clavien-Dindo classification may be inappropriate for classifying complications of emergency surgical patients, who may already have organ failures preoperatively caused by a severe disease or injury

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