The Clavien–Dindo Classification of Surgical Complications
According to Donabedian, medical quality is determined by structure, process and outcome. In surgery, outcome is still the most frequently used indicator of surgical quality. However, there is still a lack of a precise definition of a ‘good’ or ‘bad’ surgical outcome. In 1992, it was proposed that ‘negative outcome’ should be subdivided into complication, failure to cure and sequelae . Complications were defined as ‘any deviation from the normal postoperative course’. Conditions, which are inherent to the procedure and are expected to occur (such as pain or scar formation) should be discriminated from complications and be termed ‘sequelae’. Finally, diseases that remain unchanged after surgery or reoccur (e.g. R2-resected tumour or an early recurrence of an inguinal hernia) also reflect negative outcomes, either, but constitute a failure to cure rather than a complication.
The incidence of complications is still the most often used surrogate marker for surgical quality. However, we still lack a consensus on how to define and to grade surgical complications what substantially hampers the interpretation of surgical performance. A number of attempts have been made to classify surgical complications, but none of them has gained widespread acceptance. Some surgeons advocated that intuition is an appropriate guide to define what a complication might be and for grading. However, any system reporting complications must narrow the room for mistakes and subjective interpretation. Therefore, the challenge is to use a scale system, which has to be simple but must not impede accuracy or general clinical applicability.
To standardize surgical outcome reporting, we have introduced a classification of surgical complications consisting of five grades. The basic principle of this classification – termed Clavien-Dindo Classification - is based on the therapy needed to treat the complication. The classification mainly focuses on the medical perspective, with major emphasis on the risk and invasiveness of the therapy used to correct a complication
KeywordsClavien–Dindo classification Surgical complications Quality assurance Morbidity Mortality Classifications Medical quality
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