Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
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...These criteria constituted the framework of the revised classification system.(7) Before this publication, the grading system was evaluated by 150 surgeons from 10 centers around the world, indicating that the new proposal was indeed understandable, simple, and reproducible....
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...Most of the original reports (n 112, 63%) did not use terms such as “minor or major complications” in any parts of the article, which is consistent with the recommendations made in the original report.(7) Of the remaining studies (n 45, 37%) the term minor was mostly used to refer to grades I and II complications, whereas major related to grades III to V complications....
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...For example, living donor liver(86) and kidney(122) transplantation studies applied the “so-called” Clavien classification, but they based the system mostly on the initial classification,(2,136) arguing that it was appropriate for their purpose, and that the prospective database was initiated before the introduction of the new system.(7) This has resulted in a letter to the editor suggesting to respect the new system to prevent confusion and allow meaningful comparison between the data in Japan and United States....
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...With the participation of 10 centers around the world, we presented revisions in the grading system, proposing more objective criteria and some flexibility by allowing a contraction of grades to adjust to the patient population studied.(7) In contrast to the initial classification,(2) this revised system(7) rapidly gained acceptance by a number of investigators, and became increasingly used in large scale trials....
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...Another source of confusion in the literature was the terminology given to the classification system, and how it was referred to, probably because no special denomination was provided in our original publication.(7) Authors would like to refer to a name to prevent confusion with other systems....
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"Classification of surgical complica..." refers background or methods in this paper
...This perspective tends to minimize subjective interpretation and any tendency to downrate complications because it is based on hard facts.(1) This approach is particularly important in retrospective studies where postoperative problems are often poorly reported, whereas the therapy to treat a complication is well documented in both physician and nursing reports....
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...Classification of Surgical Complications The previous classification consisted of 4 severity grades.(1,9,10) Grade 1 included minor risk events not requiring therapy (with exceptions of analgesic, antipyretic, antiemetic, and antidiarrheal drugs or drugs required for lower urinary tract infection)....
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...In 1992, we proposed general principles to classify complications of surgery based on a therapy-oriented, 4-level severity grading.(1) Subsequently, the severity grading was refined and applied to compare the results of laparoscopic versus open cholecystectomy(9) and liver transplantation....
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...Definition of Negative Outcome As in the previous publication of 1992, we kept the 3 definitions of negative outcomes by differentiating complications, failure to cure, and sequelae.(1) Complications were defined as any deviation from the normal postoperative course....
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