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The Clavien-Dindo classification

The therapy used to correct a specific complication is the basis of this classification in order to rank a complication in an objective and reproducible manner.

 

It consists of 7 grades (I, II, IIIa, IIIb, IVa, IVb and V). The introduction of the subclasses a and b allows a contraction of the classification into 5 grades (I, II, III, IV and V) depending on the size of the population observed or the of the focus of a study.

 

Complications that have the potential for long-lasting disability after patient’s discharge (e.g.: paralysis of a voice cord after thyroid surgery) are highlighted in the present classification by a suffix (“d” for disability). This suffix indicates that a follow-up is required to comprehensively evaluate the outcome and related long-term quality of life.

 

The original article about the Clavien-Dindo classification has been cited over 2500 times since its publication in Annals of Surgery in 2004 .

 

The article about the five years experience with the Clavien-Dindo classification published in 2009 is the most cited paper in Annals of Surgery during the last two years.

 

Grades Definition
Grade I Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions
Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.
Grade II Requiring pharmacological treatment with drugs other than such allowed for grade I complications.
Blood transfusionsand total parenteral nutritionare also included.

Grade III

Requiring surgical, endoscopic or radiological intervention

       - IIIa

Intervention not under general anesthesia

       - IIIb

Intervention under general anesthesia

Grade IV

Life-threatening complication (including CNS complications)* requiring IC/ICU-management

       - IVa

single organ dysfunction (including dialysis)

       - IVb

multiorgandysfunction
Greade V Death of a patient
Suffix "d" If the patients suffers from a complication at the time of discharge,  the suffix  "d"  (for 'disability') is added to the respective grade of complication. This label indicates the need for a follow-up to fully evaluate the complication.

 

*brain hemorrhage, ischemic stroke, subarrachnoidalbleeding,but excluding transient ischemic attacks (TIA);IC: Intermediate care; ICU: Intensive care unit.


 
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