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Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on
Panu J Mentula1, Ari K Leppäniemi1
1Department of Abdominal Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland.
Insights
The Clavien-Dindo classification is applicable to emergency surgery complications, but Grade IV definitions need adjustment for preoperative organ dysfunction. Risk factors include comorbidities, organ dysfunction, and surgery type.
Area of Science:
- Surgery
- Surgical Complications
- Patient Outcomes
Background:
- Emergency surgery patients face high risks of complications and mortality.
- The Clavien-Dindo classification, validated for elective surgery, lacks validation in emergency settings.
- Preoperative factors for risk stratification in emergency surgical complications require investigation.
Purpose of the Study:
- To evaluate the Clavien-Dindo classification for emergency surgical patients.
- To identify preoperative risk factors for surgical complications in this cohort.
- To inform the development of a surgical complication database.
Main Methods:
- Retrospective analysis of 444 consecutive emergency general surgery patients.
- Classification of surgical complications using the Clavien-Dindo system.
- Logistic regression analysis to identify preoperative risk factors.
Main Results:
- 37% of patients had preoperative organ dysfunction.
- A modified definition for Grade IV complications (organ dysfunction) was necessary.
- Postoperative complications occurred in 25.9% of patients, with 3.2% experiencing Grade IV complications.
- Charlson comorbidity index, preoperative organ dysfunction, and surgery type predicted complications.
Conclusions:
- The Clavien-Dindo classification is usable in emergency surgery with modifications for Grade IV complications.
- Preoperative organ dysfunction must be considered when defining Grade IV complications.
- Comorbidities, preoperative organ dysfunction, and surgery type are crucial for risk stratification.
Background:
Patients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The aim of the current study was to evaluate the Clavien-Dindo classification of surgical complications in emergency surgical patients and to study preoperative factors for risk stratification that should be included into a database of surgical complications.
Methods:
A cohort of 444 consecutive patients having emergency general surgery during a three-month period was retrospectively analyzed. Surgical complications were classified according to the Clavien-Dindo classification. Preoperative risk factors for complications were studied using logistic regression analysis.
Results:
Preoperatively 37 (8.3%) patients had organ dysfunctions. Emergency surgical patients required a new definition for Grade IV complications (organ dysfunctions). Only new onset organ dysfunctions or complications that significantly contributed to worsening of pre-operative organ dysfunctions were classified as grade IV complications. Postoperative complications developed in 115 (25.9%) patients, and 14 (3.2%) patients developed grade IV complication. Charlson comorbidity index, preoperative organ dysfunction and the type of surgery predicted postoperative complications.
Conclusions:
The Clavien-Dindo classification of surgical complications can be used in emergency surgical patients but preoperative organ dysfunctions should be taken into account when defining postoperative grade IV complications. For risk stratification patients' comorbidities, preoperative organ dysfunctions and the type of surgery should be taken into consideration.
