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.
|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.
|Requiring surgical, endoscopic or radiological intervention|
|Intervention not under general anesthesia|
|Intervention under general anesthesia|
|Life-threatening complication (including CNS complications)* requiring IC/ICU-management|
|single organ dysfunction (including dialysis)|
|Grade V||Death of a patient|
*brain hemorrhage, ischemic stroke, subarrachnoidalbleeding,but excluding transient ischemic attacks (TIA);IC: Intermediate care; ICU: Intensive care unit.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-213.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250(2):187-196.
Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013; 258(1):1-7.