Clavien et al proposed a classification for complications associated with surgical procedures. This can be used in Quality Assurance Programs to standardize reporting and comparison of problems.
Terminology:
(1) complication: unexpected event not intrinsic to the procedure
(2) sequelae: unexpected event intrinsic to the procedure
(3) failure: procedure where the purpose of the procedure is not fulfilled
Complications:
(1) usually occur as a result of a procedure
(2) involve deviations from the ideal course and tend to impair or delay complete recovery
(3) result in changes to the management of the patient, which may be diagnostic or therapeutic
(4) result in morbidity and/or mortality, with the patient suffering either directly from the direct effect of the complication or as a result of additional procedures needed for diagnosis and treatment
(5) tend to occur during the performance of the procedure or during recovery from the procedure, although some may be delayed in presentation
|
Grade of Complication |
Description |
|---|---|
|
0 |
none |
|
I |
minor alterations from the ideal post-operative course, not life-threatening, with no lasting disability, do not significantly extend the hospital stay |
|
II |
potentially life-threatening but without residual disability; includes all iatrogenic injuries not resulting in organ resection, residual disability, or death |
|
III |
significant residual disability, including organ resection or persistent life-threatening condition |
|
IV |
result in death |
Features of Grade I complications:
(1) includes those that resolve spontaneously if left untreated
(2) include those that can be cleared by the patient following instructions
(3) can be managed by a simple bedside procedure with no or local analgesia
(4) drug therapy consists of analgesics, antipyretics, antiemetics, antidiarrheal agents, antibiotics for urinary tract infection, and drugs for urinary retention
(5) does not include iatrogenic injury
(6) may extend the hospital stay up to (but not including) 2 times the mean hospital stay for that procedure
|
Subset of Grade II |
Description |
|---|---|
|
IIA |
does not require an invasive procedure; require drug therapy not included in Group I, total parenteral nutrition, or blood transfusion |
|
IIB |
requires invasive procedure |
Features of Grade II complications:
(1) may extend the hospital stay 2 or more times the mean hospital stay for that procedure
(2) invasive procedures include image-directed drainage, endoscopy, tube placement, reoperation, or a procedure requiring more than a local anesthetic
The Appendix (page 525-536) lists the different complications of cholecystectomy and the corresponding Grades.
Purpose: To classify a complication of a surgical procedure using the grading scheme of Clavien et al.
Objective: criteria for diagnosis, complications
ICD-10: T81.9,
