Validation of a modified Clavien-Dindo Classification for postoperative complications in orthopedic surgery
DOI:
https://doi.org/10.31053/1853.0605.v77.n3.27931Keywords:
postoperative complications, orthopedics, health systemsAbstract
Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoperative course.
Reporting of PCs remains a challenge, multiple classification systems have been proposed, however these have not been validated across surgical specialties. Clavien and Dindo (DCCS) developed a system for General Surgery and has been adopted in different fields. Nonetheless, this classification has not been adapted to Orthopedics. The objective of this study was to adapt the Clavien-Dindo classification to orthopedic scenarios and to determine the intra and interobserver reliability.
Methods: The designer team adapted the Clavien Dindo classification to orthopedic scenarios. Ten orthopedic observers with different degrees of training and experience were selected to evaluate the classification. 48 simulated clinical scenarios of complications and another negative outcomes such as failure to cure and sequelae were sent by electronic format independently. A second round of scoring was performed 30 days later to assess the intraobserver concordance.
Results: We found a high interobserver and intraobserver reliability for both the first and second evaluation (Kappa 0.88 and 0.91, respectively). In addition, the intraobserver analysis showed a very good correlation (Kappa 0.93).
Discussion: The DCCS classification has been developed for general surgery and has been widely applied in the different surgical subspecialties. In Orthopedics, this classification was validated to hip and pediatric surgery. Therefore, our study involved an adaptation of the classification to general and specific orthopedic scenarios of the different orthopedic subspecialties. This classification may be a useful tool for documenting complications in orthopedic surgery.
Keywords: postoperative complications; orthopedics; health systems
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- Cleveland O, Piuzzi NS, Strnad G, Brooks P, Hettrich CM, Higuera-Rueda C, Iannotti J, Kattan MW, Molloy R, Lynch TS, Milinovich A, Ricchetti ET, Rosneck J, Schickendantz M, Spindler KP; OME Cleveland Clinic Orthopaedics. Implementing a Scientifically Valid, Cost-Effective, and Scalable Data Collection System at Point of Care: The Cleveland Clinic OME Cohort. J Bone Joint Surg Am. 2019 Mar 6;101(5):458-464. doi: 10.2106/JBJS.18.00767.
- Horton R. Surgical research or comic opera: questions, but few answers. Lancet. 1996 Apr 13;347(9007):984-5. doi: 10.1016/s0140-6736(96)90137-3.
- Goldhahn S, Sawaguchi T, Audigé L, Mundi R, Hanson B, Bhandari M, Goldhahn J. Complication reporting in orthopaedic trials. A systematic review of randomized controlled trials. J Bone Joint Surg Am. 2009 Aug;91(8):1847-53. doi: 10.2106/JBJS.H.01455.
- Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992 May;111(5):518-26.
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae.
- Chun YS, Vauthey JN, Ribero D, Donadon M, Mullen JT, Eng C, Madoff DC, Chang DZ, Ho L, Kopetz S, Wei SH, Curley SA, Abdalla EK. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg. 2007 Nov;11(11):1498-504; discussion 1504-5. doi: 10.1007/s11605-007-0272-2.
- Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187-96. doi: 10.1097/SLA.0b013e3181b13ca2.
- DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006 Dec;244(6):931-7; discussion 937-9. doi: 10.1097/01.sla.0000246856.03918.9a.
- de Santibañes E, Ardiles V, Gadano A, Palavecino M, Pekolj J, Ciardullo M. Liver transplantation: the last measure in the treatment of bile duct injuries. World J Surg. 2008 Aug;32(8):1714-21. doi: 10.1007/s00268-008-9650-5.
- Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey JN, Ludwig KA, Mantyh CR, Morse MA, Clary BM. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007 Dec;14(12):3481-91. doi: 10.1245/s10434-007-9522-5.
- Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg. 2007 Nov;94(11):1386-94. doi: 10.1002/bjs.5836..
- Seda-Neto J, Godoy AL, Carone E, Pugliese V, Fonseca EA, Porta G, Pugliese R, Miura IK, Baggio V, Kondo M, Chapchap P. Left lateral segmentectomy for pediatric live-donor liver transplantation: special attention to segment IV complications. Transplantation. 2008 Sep 15;86(5):697-701. doi: 10.1097/TP.0b013e318183ed22.
- Sink EL, Leunig M, Zaltz I, Gilbert JC, Clohisy J; Academic Network for Conservational Hip Outcomes Research Group. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res. 2012 Aug;470(8):2220-6. doi: 10.1007/s11999-012-2343-2.
- Dodwell ER, Pathy R, Widmann RF, Green DW, Scher DM, Blanco JS, Doyle SM, Daluiski A, Sink EL. Reliability of the Modified Clavien-Dindo-Sink Complication Classification System in Pediatric Orthopaedic Surgery. JB JS Open Access. 2018 Oct 23;3(4):e0020. doi: 10.2106/JBJS.OA.18.00020.
- Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016 Jun;15(2):155-63. doi: 10.1016/j.jcm.2016.02.012. Epub 2016 Mar 31. Erratum in: J Chiropr Med. 2017 Dec;16(4):346.
- Lebude B, Yadla S, Albert T, Anderson DG, Harrop JS, Hilibrand A, Maltenfort M, Sharan A, Vaccaro AR, Ratliff JK. Defining "complications" in spine surgery: neurosurgery and orthopedic spine surgeons' survey. J Spinal Disord Tech. 2010 Dec;23(8):493-500. doi: 10.1097/BSD.0b013e3181c11f89.
- Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010 Feb;468(2):555-64. doi: 10.1007/s11999-009-1138-6.
- Sink EL, Beaulé PE, Sucato D, Kim YJ, Millis MB, Dayton M, Trousdale RT, Sierra RJ, Zaltz I, Schoenecker P, Monreal A, Clohisy J. Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am. 2011 Jun 15;93(12):1132-6. doi: 10.2106/JBJS.J.00794.
- Willhuber GC, Stagnaro J, Petracchi M, Donndorff A, Monzon DG, Bonorino JA, Zamboni DT, Bilbao F, Albergo J, Piuzzi NS, Bongiovanni S. Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina. SICOT J. 2018;4:26. doi: 10.1051/sicotj/2018027
- Camino Willhuber G, Elizondo C, Slullitel P. Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery. Global Spine J. 2019 May;9(3):279-286. doi: 10.1177/2192568218792053.
- Bellut D, Burkhardt JK, Schultze D, Ginsberg HJ, Regli L, Sarnthein J. Validating a therapy-oriented complication grading system in lumbar spine surgery: a prospective population-based study. Sci Rep. 2017 Sep 18;7(1):11752. doi: 10.1038/s41598-017-12038-7.
- Basques BA, Anandasivam NS, Webb ML, Samuel AM, Lukasiewicz AM, Bohl DD, Grauer JN. Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion. Spine (Phila Pa 1976). 2015 Nov;40(22):1792-7. doi: 10.1097/BRS.0000000000001047.
- Zheng F, Cammisa FP Jr, Sandhu HS, Girardi FP, Khan SN. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976). 2002 Apr 15;27(8):818-24. doi: 10.1097/00007632-200204150-00008.
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