Reliability of the Modified Clavien-Dindo-Sink Complication Classification System in Pediatric Orthopaedic Surgery

Abstract

Background: There is no standardized complication classification system that has been evaluated for use in pediatric or general orthopaedic surgery. Instead, subjective terms such as major and minor are commonly used. The Clavien-Dindo-Sink complication classification system has demonstrated high interrater and intrarater reliability for hip-preservation surgery and has increasingly been used within other orthopaedic subspecialties. This classification system is based on the magnitude of treatment required and the potential for each complication to result in long-term morbidity. The purpose of the current study was to modify the Clavien-Dindo-Sink system for application to all orthopaedic procedures (including those involving the spine and the upper and lower extremity) and to determine interrater and intrarater reliability of this modified system in pediatric orthopaedic surgery cases. Methods: The Clavien-Dindo-Sink complication classification system was modified for use with general orthopaedic procedures. Forty-five pediatric orthopaedic surgical scenarios were presented to 7 local fellowship-trained pediatric orthopaedic surgeons at 1 center to test internal reliability, and 48 scenarios were then presented to 15 pediatric orthopaedic surgeons across the United States and Canada to test external reliability. Surgeons were trained to use the system and graded the scenarios in a random order on 2 occasions. Fleiss and Cohen kappa (κ) statistics were used to determine interrater and intrarater reliabilities, respectively. Results: The Fleiss κ value for interrater reliability (and standard error) was 0.76 ± 0.01 (p < 0.0001) and 0.74 ± 0.01 (p < 0.0001) for the internal and external groups, respectively. For each grade, interrater reliability was good to excellent for both groups, with an overall range of 0.53 for Grade I to 1 for Grade V. The Cohen κ value for intrarater reliability was excellent for both groups, ranging from 0.83 (95% confidence interval [CI], 0.71 to 0.95) to 0.98 (95% CI, 0.94 to 1.00) for the internal test group and from 0.83 (95% CI, 0.73 to 0.93) to 0.99 (95% CI, 0.97 to 1.00) for the external test group. Conclusions: The modified Clavien-Dindo-Sink classification system has good interrater and excellent intrarater reliability for the evaluation of complications following pediatric orthopaedic upper extremity, lower extremity, and spine surgery. Adoption of this reproducible, reliable system as a standard of reporting complications in pediatric orthopaedic surgery, and other orthopaedic subspecialties, could be a valuable tool for improving surgical practices and patient outcomes.

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series

“…In addition to demographics, details about postoperative complications related to the SPLATT were collected and rated according to the Modified Clavien-Dindo (MCD) complication rating system. 21 - 23 Postoperative recurrence of pes varus, development of valgus foot deformities, need for, and the type of revision surgeries were also recorded.…”

Validation of a modified Clavien-Dindo Classification for postoperative complications in orthopedic surgery

“…In their adapted system; grades 3A/B and 4A/B were replaced for grade 3 and 4. This new adapted classification was recently applied in pediatric orthopaedic surgery with a good interrater reliability 14 . Based on Sink et al's study, we aimed to develop a new adaptation of the Clavien-Dindo system that could be applicable in every orthopedic scenario.…”

“…Dindo et al 5 in 2004 modified the original classification by developing a five-grade system of increasing severity (the Clavien-Dindo Classification system, DCCS), which was rapidly adapted across general surgery and multiple subspecialties [6][7][8][9][10][11][12] . In orthopedic surgery, the reliability of this classification was assessed and utilized only within the scope of hip preservation and pediatric orthopaedic surgery [13][14] ; however, no validation in general orthopaedic scenarios has been performed. Since there is a need for a universal, specialtyoriented classification system for recording postoperative complications after orthopedic procedures, we aimed to develop and validate the use of the Clavien-Dindo Classification in orthopedic surgery…”

Neglected Fractures of the Lateral Humeral Condyle in Children; Which Treatment for Which Condition?

“…Complications were classified according to the Clavien–Dindo–Sink (CDS) system; those with CDS > 2 were considered major complications [ 4 , 22 ]. Clinical and functional scores were recorded at baseline and at final follow-up.…”