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Clavien-Dindo Classification of 
Surgical Complications 
Stephen Chapman 
STARSurgII : DISCOVER Protocol Launch 
16th Sept...
• Measure of morbidity 
• Any deviation from the normal postoperative 
course (grades I-V) 
• Classification via therapeut...
Definitions 
STARSurgII : DISCOVER Protocol Launch 
16th September 2014, Royal College of Surgeons of England 
I 
Any devi...
STARSurgII : DISCOVER Protocol Launch 
• Thirty-day complications 
 Day of surgery (day 1) – day 30 
16th September 2014,...
STARSurgII : DISCOVER Protocol Launch 
16th September 2014, Royal College of Surgeons of England
STARSurgII : DISCOVER Protocol Launch 
16th September 2014, Royal College of Surgeons of England
Example 1: 
A 52 year old man underwent gastrectomy for malignancy. Six 
days post-operatively he had left sided facial an...
Example 2: 
A 65 year old man underwent elective left hepatectomy for 
resection of hepatocellular carcinoma (HCC). Follow...
Example 3: 
A 69 year old lady underwent laparoscopic cholecystectomy for 
cholecystitis. Shortly after the operation, she...
Example 4: 
A 52 year old man underwent elective left hemicolectomy for 
malignancy. In the days following the procedure h...
Example 5: 
A 59 year old man underwent living donor liver transplantation. 
His post-operative course was uncomplicated, ...
Example 6: 
A 41 year old lady underwent anterior resection for a rectal 
tumour. On the first post-operative night he spi...
Example 7: 
A 61 year old man underwent femoral-popliteal bypass for 
worsening arterial insufficiency. Post-operatively, ...
Example 8: 
A 34 year old man underwent laparoscopic appendicectomy for 
acute appendicitis. Post-operatively, he develope...
Take home points… 
• Classification of morbidity via therapeutic consequence 
• Primary outcome measure for the DISCOVER A...
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Discover Clavien-Dindo Classification

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STARSurg DISCOVER 2014 Guide to Clavien-Dindo Classification

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Discover Clavien-Dindo Classification

  1. 1. Clavien-Dindo Classification of Surgical Complications Stephen Chapman STARSurgII : DISCOVER Protocol Launch 16th September 2014, Royal College of Surgeons of England
  2. 2. • Measure of morbidity • Any deviation from the normal postoperative course (grades I-V) • Classification via therapeutic consequence • Grade allocated to each complication identified STARSurgII : DISCOVER Protocol Launch 16th September 2014, Royal College of Surgeons of England
  3. 3. Definitions STARSurgII : DISCOVER Protocol Launch 16th September 2014, Royal College of Surgeons of England I Any deviation from the normal postoperative course without the need for pharmacological treatment other than the “allowed therapeutic regimens”, or surgical, endoscopic and radiological interventions II Requiring 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. IV Life-threatening complication requiring critical care management; CNS complications including brain haemorrhage and ischemic stroke (excluding TIA), sub-arrachnoidal bleeding. V Death of a patient
  4. 4. STARSurgII : DISCOVER Protocol Launch • Thirty-day complications  Day of surgery (day 1) – day 30 16th September 2014, Royal College of Surgeons of England • Categories: • Cardiovascular • Metabolic • Neurological • Renal • Respiratory • Surgical • Miscellaneous
  5. 5. STARSurgII : DISCOVER Protocol Launch 16th September 2014, Royal College of Surgeons of England
  6. 6. STARSurgII : DISCOVER Protocol Launch 16th September 2014, Royal College of Surgeons of England
  7. 7. 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. Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  8. 8. 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. Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  9. 9. 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. Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  10. 10. 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. Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  11. 11. 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. Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  12. 12. 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. Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  13. 13. 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. Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  14. 14. 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 Classification? STARSurgII : DISCOVER Protocol Launch Eligible? 16th September 2014, Royal College of Surgeons of England
  15. 15. 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! STARSurgII : DISCOVER Protocol Launch 16th September 2014, Royal College of Surgeons of England

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