Assessment of the Clavien-Dindo classification system for complications in head and neck surgery

Monteiro, Eric; Sklar, Michael C.; Eskander, Antoine; Almeida, John R. de; Shrime, Mark G.; Gullane, Patrick; Irish, Jonathan C.; Gilbert, Ralph W.; Brown, Dale; Higgins, Kevin; Enepekides, Danny; Goldstein, David P.

doi:10.1002/lary.24817

Cited by 80 publications

(62 citation statements)

References 14 publications

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“…Clavien-Dindo Classification Score I complications were seen in six patients and were without exceptions secondary bleedings [11]. A light secondary bleeding according to a grade A-C described by Sarny et al in 2011 was observed in five patients, which was effectively treated with electro cautery or conservative therapy [13].…”

Section: Surgical Complicationsmentioning

confidence: 90%

“…In random laterality, the tonsillar pillars were approximated on one side with an interrupted suture and on the opposite side with a running suture. Outcome parameters were incidence of suture dehiscence within an observation period of 21 days postoperatively, time needed to perform the suture in minutes and incidence of postoperative complications according to the Clavien-Dindo classification [11].…”

Section: Methodsmentioning

confidence: 99%

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Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Steinbichler

Bender

Giotakis

et al. 2017

Eur Arch Otorhinolaryngol

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Background Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture. Methods Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded. Results During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5-11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p < 0.001). Postoperative bleedings occurred in 4/28 running sutures and 2/28 interrupted sutures. Conclusion The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.

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Section: Surgical Complicationsmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Steinbichler

Bender

Giotakis

et al. 2017

Eur Arch Otorhinolaryngol

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“…Most studies broadly define complications as medical or surgical. 11 We also graded complications according to the Clavien-Dindo classification, independently validated in head and neck surgical cases, 22 so that complications could be evaluated based on the severity of their intervention according to a predefined scale. Clark et al and Patel et al defined a major medical or surgical complication as any adverse event requiring intervention or affecting length of stay.…”

Section: Evaluating Postoperative Complicationsmentioning

confidence: 99%

“…What makes our study unique is that our definition of the postoperative complication is derived from previous work where all postoperative events for a similar patient cohort were first collected and then analyzed to determine which events could be discriminated from the expected postoperative course and also accurately recorded between patients. 11 We also graded complications according to the Clavien-Dindo classification, independently validated in head and neck surgical cases, 22 so that complications could be evaluated based on the severity of their intervention according to a predefined scale.…”

Section: Evaluating Postoperative Complicationsmentioning

confidence: 99%

Intraoperative and postanesthesia care unit fluid administration as risk factors for postoperative complications in patients with head and neck cancer undergoing free tissue transfer

et al. 2019

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Background: This study aims to evaluate the impact of perioperative fluid administration, defined as fluid delivered intraoperatively and in the postanesthesia care unit, on postoperative outcomes. Methods: Medical records of 102 patients with oral cavity squamous cell carcinoma undergoing free flap reconstruction between January 2011 and December 2015 were reviewed. The primary endpoint was development of a postoperative complication according to the Clavien-Dindo classification. Perioperative factors recorded were Washington University Head and Neck Comorbidity Index, operating time, vasopressor use, blood loss, intraoperative fluid, and perioperative fluid. Results: Greater perioperative fluid administration was independently associated with surgical complications, flap complications, overall incidence of any complication, and increased length of stay. Greater intraoperative fluid administration was independently associated with higher rates of surgical complications. Intraoperative delivery of vasopressors was not associated with flap or surgical complications. Conclusion: Receiving less perioperative fluid was associated with fewer complications and decreased length of stay. K E Y W O R D S free tissue transfer, head and neck cancer, intraoperative fluid, oral cavity squamous cell carcinoma, perioperative fluid, postanesthesia care unit, postoperative complication

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“…1–3 One study has assessed whether the CD classification is suitable for classifying complications after head and neck reconstruction, whereas another has identified the factors that lead to major (CD grade III–V) complications. 4,5 However, little has been published about the efficacy of the CD classification in larynx-preserving esophageal reconstruction.…”

mentioning

confidence: 99%

Usefulness of the Clavien–Dindo Classification in Understanding the Limitations and Indications of Larynx-preserving Esophageal Reconstruction

Umezawa

Nakao

Matsutani

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:The Clavien–Dindo (CD) classification is used to evaluate the severity of surgical complications. However, its usefulness in esophageal reconstruction has not been reported. To address this, this case series study used the CD classification to evaluate the complications after cervical esophageal reconstruction with free jejunum transfer or supercharged pedicled intestinal transfer.Methods:All consecutive patients who underwent esophageal cancer surgery with larynx-preserving free jejunum or pedicled ileocolic transfer in June 2012–December 2015 were identified. The postoperative complications were classified using the CD classification.Results:In total, 22 patients (20 men and 2 women; mean age, 63.3 years) underwent esophageal cancer reconstruction with larynx-preserving free jejunum transfer (n = 9) and supercharged pedicled intestinal transfer (n = 13). Seven patients underwent prophylactic tracheotomy. Four patients underwent emergent tracheotomy 1 or 5 days after surgery. The most frequent complication was recurrent nerve paralysis (RNP) (n = 8). Of these 8 RNP cases, 6 and 2 were classified as CD I and III complications, respectively. Pneumonia was the next most common complication (n = 7). Of these 7 pneumonia cases, 5 and 2 were classified as CD II and III, respectively. There were 2 cases of intestinal anastomosis leakage (CD II and III). On average, patients were able to start oral alimentation 15.1 (9–35) days after surgery.Conclusions:Our analysis with the CD classification suggested that vascularized free jejunum transfer or supercharge-drainage pedicled ileocolic transfer prevents postoperative intestinal anastomosis leakage and that prophylactic tracheotomy is especially indicated in cases with significant surgical damage in the cervical region.

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Assessment of the Clavien-Dindo classification system for complications in head and neck surgery

Abstract: N/A.

Cited by 80 publications

References 14 publications

Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Intraoperative and postanesthesia care unit fluid administration as risk factors for postoperative complications in patients with head and neck cancer undergoing free tissue transfer

Usefulness of the Clavien–Dindo Classification in Understanding the Limitations and Indications of Larynx-preserving Esophageal Reconstruction

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