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

Grégoire B Morand,Jörg E Bohlender,Nanina Anderegg,Tobias Kleinjung,Martina A Broglie,Dorothe Veraguth,Michael B Soyka,Christof Röösli,David Holzmann,Alexander M Huber

doi:10.3389/fsurg.2021.638057

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.

Highlights

The Clavien–Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them
As this report is a survey study with fictional clinical scenarios, no ethics approval is required according to the local ethics review board committee, Kantonale Ethikkomission Zürich
The survey was completed by 77 respondents, of which 45 respondents (58.4%) completed the survey fully

Summary

Introduction

The Clavien–Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them. In otolaryngology–head and neck surgery, complications such as sensorineural hearing loss, loss of smell, facial nerve palsy, or recurrent laryngeal nerve palsy would be graded quite mildly on a Clavien–Dindo classification, as they usually do not require intensive care unit treatment or endanger the life of the patient. These complications may be very bothersome and among the most important for surgeons, patients, and family

Methods

Results

Conclusion