discover clavien-dindo classification

STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England

Clavien-Dindo Classification of Surgical Complications

Stephen Chapman

• Measure of morbidity

• Any deviation from the normal postoperative course (grades I-V)

• Classification via therapeutic consequence

• Grade allocated to each complication identified



Definitions

IAny deviation from the normal postoperative course without the need for pharmacological treatment other than the “allowed therapeutic regimens”, or surgical, endoscopic and radiological interventions

IIRequiring pharmacological treatment with drugs beyond those allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

III Requiring surgical, endoscopic or radiological intervention.

IVLife-threatening complication requiring critical care management; CNS complications including brain haemorrhage and ischemic stroke (excluding TIA), sub-arrachnoidal bleeding.

V Death of a patient


• Thirty-day complications Day of surgery (day 1) – day 30

• Categories:

• Cardiovascular• Metabolic• Neurological• Renal• Respiratory• Surgical• Miscellaneous


Example 1: A 52 year old man underwent gastrectomy for malignancy. Six days post-operatively he had left sided facial and limb weakness. His CT head scan showed no acute changes. He was not thrombolysed.

Several hours later the weakness resolved spontaneously. A diagnosis of transient ischaemic attack was made and aspirin 75mg OD was

started.

Eligible? Classification?


Example 2: A 65 year old man underwent elective left hepatectomy for

resection of hepatocellular carcinoma (HCC). Following surgery he experienced significant post-operative nausea and vomiting

(PONV). The symptoms settled with adequate anti-emetic therapy. He also developed a wound infection requiring

antibiotics according to local policy. Eligible?

Classification?


Example 3: A 69 year old lady underwent laparoscopic cholecystectomy for cholecystitis. Shortly after the operation, she developed severe abdominal pain and fever. A bile leak was confirmed and fixed during emergency laparotomy. She recovered with no further

complications.



Example 4: A 52 year old man underwent elective left hemicolectomy for malignancy. In the days following the procedure he developed

pneumonia and was started on empirical antibiotic therapy. His breathing continued to deteriorate, leading to critical care escalation with eventual ventilatory support. He recovered

following a prolonged stay in critical care.Eligible?

Classification?


Example 5: A 59 year old man underwent living donor liver transplantation.

His post-operative course was uncomplicated, apart from moderate PONV requiring anti-emetic therapy.




Example 6: A 41 year old lady underwent anterior resection for a rectal

tumour. On the first post-operative night he spiked a temperature and was given intravenous paracetamol. On day 2

he was hypokalaemic and was administered oral potassium supplementation.



Example 7: A 61 year old man underwent femoral-popliteal bypass for

worsening arterial insufficiency. Post-operatively, he suffered an acute myocardial infarction leading to cardiac arrest.

Resuscitation attempts were unsuccessful and the patient was pronounced dead shortly after.



Example 8: A 34 year old man underwent laparoscopic appendicectomy for

acute appendicitis. Post-operatively, he developed an intra-abdominal collection requiring drainage in theatre. Two days

later he developed a temperature. Nitrites were identified in his urine, following which antibiotics were commenced

Take home points…

• Classification of morbidity via therapeutic consequence

• Primary outcome measure for the DISCOVER Audit

• Grade for each identified complication

• QUALITY ASSURANCE – Please complete online e-module prior to embarking on data collection!


discover clavien-dindo classification

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