Abstract
Because of limitations caused by unique complications of free flap reconstruction, the Clavien–Dindo classification was modified to include grade “IIIc” for “partial or total free flap failure.” From 2013 to 2018, 116 patients who had undergone free flap reconstruction for head and neck cancer with grade III or higher postoperative complications were grouped using the “Modified” Clavien–Dindo classification. Alcoholism displayed significant predictive effects between grade IIIb and IIIc (72.7% vs. 50%, p = 0.028). Significant differences were observed between grade IIIb and IIIc in the duration of hospital stay (23.1 ± 10.1 vs. 28.6 ± 11.9 days, p = 0.015), duration of intensive care unit stay (6.0 ± 3.4 vs. 8.7 ± 4.3 days, p = 0.001), reoperation times during the current hospitalization (1.4 ± 0.8 vs. 2.0 ± 1.0 times, p < 0.001), and wound infection rate (29.9% vs. 62.5%, p = 0.002). The severity levels were significantly positively correlated with reoperation times during the current hospitalization (p < 0.001), ICU stay (p = 0.001), and hospital stay (p < 0.001). The modified Clavien–Dindo classification with grade IIIc describes the perioperative complications of head and neck free flap reconstruction to predict clinical outcomes based on severity.
Highlights
A standardized grading system of surgical complications is necessary for improving the quality of perioperative patient care, decision making, and the consistency of interpretation between professionals
The patients were grouped into grade IIIa (4 patients, 3.4%), IIIb (77 patients, 66.4%), IIIc (32 patients, 27.6%), and IVa (3 patients, 2.6%) according to the modified Clavien–Dindo classification system
Perioperative factors for outcome prediction were analyzed, and the incidence of alcoholism was higher in the grade IIIb group (72.7%) than in the grade IIIc group (50%; p = 0.028)
Summary
A standardized grading system of surgical complications is necessary for improving the quality of perioperative patient care, decision making, and the consistency of interpretation between professionals. The Clavien–Dindo classification is widely used in general and urologic surgery because of its validity and reliability [1,2,3,4,5,6]. It was first described by Clavien and Dindo in 2004 [1]. Grade I of the Clavien–Dindo classification was defined as any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, or radiological interventions. Grade III of the Clavien–Dindo classification was originally defined as surgical complications requiring surgical, endoscopic, or radiological intervention, and was further classified into grade IIIa and IIIb depending on whether the intervention was performed under
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
