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    International Journal of Innovative Science and Research Technology
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    There is no surgery without any complication

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    A Clinical Study of Clavien-Dindo Classification of Postoperative Complications Following Major Abdominal Surgeries in a Tertiary Care Centre

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    There is no surgery without any complication

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    12 views4 pages

    A Clinical Study of Clavien-Dindo Classification of Postoperative Complications Following Major Abdominal Surgeries in A Tertiary Care Centre

    Uploaded by

    International Journal of Innovative Science and Research Technology
    There is no surgery without any complication

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology

    ISSN No:-2456-2165

    A Clinical Study of Clavien-Dindo Classification


    of Postoperative Complications Following Major
    Abdominal Surgeries in a Tertiary Care Centre
    Dr. R. ASHOK REDDY1, Dr. P. SUBASH CHANDRA2, Dr. Ch. BALAJI3, Dr. G. SREE GAYATHRI4
    PROFESSOR & HOD1, ASSISTANT PROFESSOR2,3, FINAL YEAR POST GRADUATE4
    DEPARTMENT OF GENERAL SURGERY GREAT EASTERN MEDICAL SCHOOL SRIKAKULAM

    Abstract:- There is no surgery without any complication. III. MATERIAL & METHODS
    It is every surgeon’s aim to minimize Postoperative
    complications. It is therefore necessary to evaluate and  Prospective, cross sectional, hospital based study in
    classify the complications in an easiest possible way. patients admitted at GEMS medical college for major
    Clavien – Dindo classification is a simple and acceptable abdominal surgeries that are both elective and emergency.
    way to evaluate post-surgical complications in patients  A total of 109 cases those who underwent major
    undergoing major abdominal surgeries. abdominal surgeries from January 2021 to August 2021
    have been studied.
    Keywords:- Complications, Clavein-Dindo, post-operative,  A detailed history was taken and patients were evaluated
    major, abdominal surgeries. preoperatively based on history, associated co-morbidities
    and other investigations.
    I. INTRODUCTION
    A. INCLUSION CRITERIA
     Everysurgerycomeswithitsowncomplications. The study included all patients hospitalized to the
     The surgical team continually strives to keep the general surgery department who were older than 18 and
    occurrence of serious problems for patients interested in taking part.
    experiencing any type of surgery at a minimum..
     Frequentlythefunctionalresultsoftheoperationare B. EXCLUSION CRITERIA:
    compromised bycomplications.  Patients who underwent abdominal surgery earlier.
     Insomecasesthepatientneverrecoverstothe preoperative  Pregnancy
    level of function.  Surgeries for carcinomas
     The significant and difficult part is the suffering borne by  Immunocompromised patients
    the patient who enters the hospital anticipating an  Complications developed after 30 days of surgery
    uneventful surgery.  Those not willing to participate.
     Appropriate appraisal of the surgeon's work and perhaps
    advancement in the surgical field have been impeded by IV. STATISTICAL ANALYSIS OF DATA
    the lack of agreement within the surgical field on the
    accurate manner to report surgical complications..  Data collected was entered into excel sheets and results
     Clavien-Dindo classification is simple and acceptable way were analyzed using SPSS.20 software.
    in evaluating post-surgical problems in patients  The distribution of the variables was determined at 67%
    undergoing major abdominal surgeries. with a 20% precision and a 95% confidence interval.

    II. AIMS & OBJECTIVES V. SURGERIES INCLUDED IN OUR STUDY

     The aim of this study is to assess the postoperative  LAPAROSCOPIC CHOLECYSTECTOMY.


    complications in patients who underwent major abdominal  OPEN CHOLECYSTECTOMY.
    surgeries and to grade them according to Clavien-Dindo  EXPLORATORY LAPAROTOMY FOR ACUTE
    classification. INTESTINAL OBSTRUCTION.
     To establish the usefulness of Clavien-Dindo  EXPLORATORY LAPAROTOMY FOR HOLLOW
    classification in postoperative assessment of abdominal VISCUS PERFORATION.
    surgeries.  SPLEENECTOMY.

    VI. RESULTS

     AGE DISTRIBUTION: The age of patients ranged from


    18-68years with a mean age of 43.78years and most
    patients are between 40-50years.

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    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165

    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    0
    18-28 28-38 38-48 48-58 58-68

    Fig. 1: Age Distribution

    males
    females

    Fig. 2: Sex Distribution

    40

    35

    30

    25

    20

    15

    10

    0
    lap chole open chole perforation closure R&A SPLEENECTOMY
    Fig. 3: Surgery Incidence

    IJISRT23JAN297 www.ijisrt.com 1050


    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165

    DIABETES MELLITUS 19
    HYPERTENSION 17
    ANAEMIA 13

    HYPOPROTINEMIA 11

    JAUNDICE 4

    OTHERS 6

    ABSENT 39

    Table 1: Co-Morbidities

    POST OP FEVER 16
    PROLONGED ICU STAY 23

    WOUND INFECTION 11
    ANAEMIA 14

    ACUTE KIDNEY INJURY 13


    BASAL LUNG ATELECTASIS 12

    OTHERS 4

    ABSENT 15

    DEATH 1
    Table 2: Complications

    GRADES DEFINITION
    1 Any deviation from normal post op course without the need for pharmacologic treatment or
    surgical , endoscopic and radiological interventions
    2 Requiring pharmacological treatment with drugs other than such allowed for grade 1 complication.
    Blood transfusion and TPN included.
    3 Requiring endoscopic , radiological or surgical intervention
    3A Intervention not under GA
    3B Intervention under GA
    4 Life threatening complications requiring ICU management
    4A Single organ dysfunction including dialysis
    4B Multi organ dysfunction
    5 Death of patient
    Table 3: CLAVIEN-DINDO CLASSIFICATION

    VII. DISCUSSION (14.6%) followed by 18-28 years(13.7%) and 58-68


    years(10.09%).
     As a result of the ease with which the information in our  Total emergency surgeries done were 44 (40.3%)and
    database may be transformed into this classification, the elective surgeries were 65(59.6%).
    Clavien - Dindo categorization is unbiased and  Most commonly associated co morbidity was diabetes
    straightforward. (17.43%) and hypertension (15.59%) followed by anemia
     It should be emphasized that only 32.1% of patients who (11.92%) and hypoproteinemia (10.09%).
    used this approach had a normal post-operative course,  The commonest complication was prolonged ICU stay
    and 67.9% of patients experienced any variation from it. (21.1%) which was seen in patients with above mentioned
     This is as a result of the study's inclusion of emergency comorbidities as they required correction of these
    abdominal surgery. disorders.
     The common age group of presentation was 48-58 years (  Patients with anemia preoperatively and some of them
    42.2%) followed by 28-38years (19.2%) then 38-48 years postoperatively required blood transfusions putting them
    in grade 2 of Clavien-Dindo classification.

    IJISRT23JAN297 www.ijisrt.com 1051


    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165
     Out of the 13 patients that presented with acute kidney a single institute in central Rajasthan. Arch Int Surg.
    injury 4 patients required hemodialysis postoperatively 2016, 6:170-175. 10.4103/2278-9596.202365.
    putting them into grade 4A of classification and the rest [7.] Bolliger M, Kroehnert JA, Molineus F, Kandioler D,
    were treated conservatively. Schindl M, Riss P: Experiences with the standardized
     Out of 12 patients with basal lung atelectasis as classification of surgical complications (Clavien-
    complication 2 patients required intubation and Dindo) in general surgery patients. Eur Surg. 2018,
    mechanical ventilation putting them into grade 3B. 50:256-261. 10.1007/s10353-018-0551-z.
     Grade 5 complication was noted in one case that was [8.] Lian B, Chen J, Li Z, Ji G, Wang S, Zhao Q, Li M.
    brought with features of peritonitis, septic shock and acute Risk Factors and Clavien–Dindo Classification of
    kidney injury. Postoperative Complications After Laparoscopic and
     Patient was operated on emergency basis and was Open Gastrectomies for Gastric Cancer: A Single-
    monitored in ICU. Patient was declared dead on second Center, Large Sample, Retrospective Cohort Study.
    post-operative day due to multi organ failure. Cancer Manag Res. 2020;12:12029-12039
     Mean ICU stay of our patients was noted to be 6.3+ 2.9 [9.] https://doi.org/10.2147/CMAR.S275621
    days.
     Patients with complications of grades 2 and 3 required
    longer stays in the intensive care unit (ICU), confirming
    the value of the Clavien-Dindo classification in
    identifying problems of various intensities.

    VIII. CONCLUSION

     To sum up, the Clavien-Dindo classification offers a


    straightforward and objective technique to record all
    problems in patients having major abdominal procedures.
     This grading method successfully separates the severity of
    complications from a typical post-operative course and
    enables the surgeon to make that distinction.
     Comparing the varied complications between various
    operations is also of special interest.

    REFERENCES

    [1.] Riccardo C, Claudio R, Raffaele P, Lucia C, Marielda


    D, Giovanni T, et. al. Assessment of complications
    according to the Clavien-Dindo classification after
    distal pancreatectomy. J Pancreas. 2011;12(2):125-
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    [2.] Vignesh R, Raza M. Assessment of postoperative
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    by clavein-dindo classification system in the Indian
    hospital setting. Paripex Indian J Res. 2016;5:6-10.
    [3.] Clavein PA, Barkun J, Oliveira MLd, Vauthey JN,
    Dindo D, Schulick RD, et al. The Clavien-Dindo
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    experience. Ann Surg. 2009;250(2):187–196.
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    https://doi.org/10.1097/sla.0b013e3181b13ca2.
    [4.] Manekk R S, Gharde P, Gattani R, et al. (May 13,
    2022) Surgical Complications and Its Grading: A
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    doi:10.7759/cureus.24963.
    [5.] Tevis SE, Kennedy GD: Postoperative complications
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    [6.] Singh A, Porwal R, Gupta HP, Sharma AK, Kumawat
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    classification of surgical complications: experience of

    IJISRT23JAN297 www.ijisrt.com 1052

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