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Modified Clavien-Dindo Classification for Adverse Events in Otolaryngology-Head and Neck Surgery
Cecelia M Hidalgo1, Eliot J Martin1, Daniel G Eyassu1
1Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
JAMA Network Open
|October 27, 2025
Summary
A new modified Clavien-Dindo Classification for otolaryngology-head and neck surgery (OHNS) was developed and validated. This tool reliably differentiates complication severity and aids in assessing surgical outcomes.
Area of Science:
- Surgical Outcomes Research
- Medical Classification Systems
- Otolaryngology-Head and Neck Surgery (OHNS)
Background:
- Adverse event reporting in OHNS is inconsistent.
- Existing Clavien-Dindo Classification lacks validation in OHNS.
- Need for a standardized system to assess complication severity and duration in OHNS.
Purpose of the Study:
- To develop and validate a modified Clavien-Dindo Classification tailored for OHNS.
- To create a system reflecting the severity and duration of harm from OHNS complications.
- To improve consistency and accuracy in reporting surgical adverse events.
Main Methods:
- Multicenter survey study involving OHNS subject matter experts (SMEs) in the US.
- Literature review to identify and summarize OHNS surgical complications (Jan 2019-Apr 2020).
- Development of a modified Clavien-Dindo Classification and validation using 35 clinical vignettes via electronic survey (Sep 2023).
Main Results:
- 43 of 106 SMEs participated (40.6% response rate).
- Moderate reliability (Krippendorff α = 0.74) in classifying complications.
- The modified classification demonstrated ability to differentiate high-grade from low-grade OHNS complications.
Conclusions:
- A modified OHNS Clavien-Dindo Classification was successfully developed and validated.
- The classification offers granular subcategorization and incorporates the Comprehensive Complication Index (CCI).
- This validated tool can enhance the assessment of surgical outcomes and standardize complication reporting in OHNS.
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