Abstract
SummaryBackgroundThe standardized Clavien-Dindo classification of surgical complications is applied as a simple and widely used tool to assess and report postoperative complications in general surgery. However, most documentation uses this classification to report surgery-related morbidity and mortality in a single field of surgery or even particular intervention. The aim of the present study was to present experiences with the Clavien-Dindo classification when applied to all patients on the general surgery ward of a tertiary referral care center.MethodsWe analyzed a period of 6 months of care on a ward with a broad range of general and visceral surgery. Discharge reports and patient charts were analyzed retrospectively and reported complications rated according to the most recent Clavien-Dindo classification version. The complexity of operations was assessed with the Austrian Chamber of Physicians accounting system.ResultsThe study included 517 patients with 817 admissions, of whom 463 had been operated upon. Complications emerged in 12.5%, of which 19% were rated as Clavien I, 20.7% as Clavien II, 13.8% as Clavien IIIa, 27.6% as Clavien IIIb, 8.6% as Clavien IVa, and 10.3% as Clavien V. No Clavien grade IVb complication occurred within the investigation. Patients having undergone more complex surgery or with higher scores experienced significantly longer lengths of hospital stay.ConclusionThe Clavien-Dindo classification can easily be used to document complication rates in general surgery, even though this collective was not included in the original validation studies of Clavien et al. and consisted of more heavily impaired patients.
Highlights
How can surgeons assess—and for that matter, even improve—their proficiency in an effort to enhance the outcome and overall experience of and for their patients?Initially, the probably most important step is to report and examine potential complications and draw lessons from them
The Clavien-Dindo classification can be used to document complication rates in general surgery, even though this collective was not included in the original validation studies of Clavien et al and consisted of more heavily impaired patients
Clavien and Dindo discarded length of stay (LOS) in this new version, since it differed too strongly between hospitals due to internal rules governing when to discharge a patient. This was shown by Peterson and colleagues in 2002, who compared the lengths of stay following close to half a million coronary artery bypass graft procedures in 587 US hospitals
Summary
How can surgeons assess—and for that matter, even improve—their proficiency in an effort to enhance the outcome and overall experience of and for their patients?Initially, the probably most important step is to report and examine potential complications and draw lessons from them. The Clavien-Dindo classification originated in 1992, when it was first introduced under the name of the “T92 score,” as validated on 650 cholecystectomies [2] This new scoring system offered the advantages of being able to compare results over different time periods within the same institution, compare different institutions, compare surgical and conservative treatments, and document operations and associated complications in a standardized way, and facilitate meta-analyses. Clavien and Dindo discarded length of stay (LOS) in this new version, since it differed too strongly between hospitals due to internal rules governing when to discharge a patient. This was shown by Peterson and colleagues in 2002, who compared the lengths of stay following close to half a million coronary artery bypass graft procedures in 587 US hospitals. Salmon showed similar results for orthopedic patients in 2013, claiming that a hospital with rapid discharge did not produce inferior outcomes or worse patient feedback [5]
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