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Validation of the Clavien-Dindo classification in plastic surgical breast procedures: A plastic surgery-specific
Emma Hutchins1, Anna Paganini2, Jonas Löfstrand1
1Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
Purpose:
To validate the Clavien-Dindo classification (CDC) in plastic surgical breast procedures and develop a plastic surgery-specific interpretation with additional suffixes to improve consistency and clinical relevance.
Methods:
This study was conducted in four parts. Consecutive clinical series comprising 647 patients across four procedure groups were analyzed to identify classification challenges and assess construct validity through associations between CDC grade, length of hospital stay (LOS), and surgical complexity. Inter-rater reliability of the original CDC was evaluated using 35 clinical scenarios graded by five plastic surgeons. A plastic surgery-specific interpretation and suffixes were developed and subsequently tested through reassessment and a structured usability evaluation.
Results:
In total, 202 complications were graded. Several recurring classification challenges, including seroma and hematoma management, donor-site complications, and the distinction between prophylactic and therapeutic treatments, were identified. LOS increased with higher CDC grade, with significantly longer hospitalization for Grade IIIb compared with Grade I (p = 0.021). Complication severity was associated with surgical complexity (p = 0.014). Inter-rater reliability for the original CDC was substantial (κ = 0.72) and improved to almost perfect with the revised interpretation (κ = 0.94) in a puposively selected subset of scenarios. The proposed suffixes enabled clinically relevant distinctions, including reconstructive failure and anatomical location of complications.
Conclusion:
The CDC demonstrates satisfactory validity and reliability in plastic surgical breast procedures. A structured, plastic surgery-specific interpretation with suffixes improves consistency and clinical relevance while preserving compatibility with the original classification.
