From the Guidelines
The Modified Clavien-Dindo score is a classification system that grades surgical complications from Grade I to Grade V, based on the interventions required to treat them, with a cumulative burden metric ranging from 0 to 100. The classification system is as follows:
- Grade I: Any deviation from the postoperative course without the need for pharmacological treatment or surgical, radiological or endoscopic intervention, including acceptable therapeutic regimens such as antiemetics, antipyretics, analgetic, diuretics, electrolytes and physiotherapy 1.
- Grade II: Requiring pharmacological treatment other than allowed for grade I, including blood transfusions, antibiotics and total parenteral nutrition 1.
- Grade III: Requiring surgical, endoscopic or radiological intervention, subdivided into IIIa (intervention under regional or local anesthesia) and IIIb (intervention under general anesthesia) 1.
- Grade IV: Life-threatening complication requiring intensive care unit management, including single-organ dysfunction (IVa) and multi-organ dysfunction (IVb) 1.
- Grade V: Patient demise 1. This system is valuable for providing an objective, reproducible assessment of surgical outcomes, facilitating comparison between different surgical techniques or institutions, and helping in quality improvement initiatives, as noted in the consensus recommendations on how to assess the quality of surgical interventions 1. The cumulative burden metric, ranging from 0 (no complication) to 100 (death), accounts for both the number and severity of the complications, and can be calculated using a web application (https://www.cci-calculator.com) 1. In addition to the Clavien-Dindo classification, other metrics such as the ‘textbook outcome’ approach, readmission rate, length of hospital stay, days alive out of hospital (DAOH) and treatment costs can be used to assess outcomes when it comes to postoperative complications 1.
From the Research
Definition of Modified Clavien-Dindo Score
The Modified Clavien-Dindo score is a classification system used to assess and report postoperative complications in various surgical specialties.
- It is based on the magnitude of treatment required and the potential for each complication to result in long-term morbidity 2, 3.
- The system has been modified and validated for use in different surgical disciplines, including pediatric orthopaedic surgery 2, adult spine surgery 3, and pancreatic surgery 4.
Classification Grades
The Modified Clavien-Dindo score consists of several grades, which are defined as follows:
- Grade I: minor complications that require no treatment or only minor intervention
- Grade II: complications that require pharmacological treatment or other non-invasive interventions
- Grade III: complications that require surgical, endoscopic, or radiological intervention
- Grade IV: life-threatening complications that require intensive care unit (ICU) management
- Grade V: death 5, 2, 3.
Reliability and Validation
The Modified Clavien-Dindo score has been shown to have good interrater and excellent intrarater reliability in various surgical specialties 2, 3.
- It has been validated for use in pancreatic surgery, where it was found to correlate with clinical outcomes and case-related remuneration 4.
- The system has also been used to evaluate the relationship between postoperative complications and oncologic outcomes after colorectal cancer resection, where it was found to be associated with adverse outcomes 6.