Abstract
BackgroundThe frequency of postoperative complications is used as an indicator of surgical quality; however, comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. A standard grading system for surgical complications is necessary to improve the quality of clinical research and reporting in head and neck reconstruction.MethodsThe aim of this study was to compare postoperative morbidity after microvascular head and neck reconstruction between patients with versus without a history of prior radiation therapy (RT) by using the Clavien–Dindo classification. A group of 274 patients was divided into two cohorts based on the history of prior RT: the RT group included 79 patients and the non-RT group included 195 patients. Postoperative (30-day) complications were compared between the groups with a nonstandardized evaluation system and the Clavien–Dindo classification.ResultsThe grades of complications according to the Clavien–Dindo classification were significantly higher in the RT group than in the non-RT group. The frequency of postoperative complications did not differ significantly between the groups according to the nonstandardized evaluation system.ConclusionsThe Clavien–Dindo classification could serve as a useful, highly objective tool for grading operative morbidity after microvascular head and neck reconstruction when comparing similar defects and methods of reconstruction. Widespread use of the Clavien–Dindo classification system would allow adequate comparisons of surgical outcomes among different surgeons, centers, and therapies.
Highlights
Free flap surgery has become the standard method of head and neck reconstruction, and the outcomes of these procedures have been investigated by several authors. [1] The frequency of postoperative complications is used as an indicator of surgical quality; comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. [2] Most reports have used a nonstandardized system for evaluating postoperative complications and have not taken the severity of complications into account
The grades of complications according to the Clavien–Dindo classification were significantly higher in the radiation therapy (RT) group than in the non-RT group
The classification was initially developed by Clavien in 1992 for reporting negative outcomes after cholecystectomy and was modified by Dindo et al in 2004 to increase its accuracy and acceptability in clinical practice. [5, 6] The major characteristic of the Clavien–Dindo classification (CDC) system is that the severity of a complication is graded based on the type of therapy required to treat the complication
Summary
The frequency of postoperative complications is used as an indicator of surgical quality; comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. A standard grading system for surgical complications is necessary to improve the quality of clinical research and reporting in head and neck reconstruction
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