Assessment of Complications According to the Clavien-Dindo Classification After Distal Pancreatectomy

  • Riccardo Casadei Department of Surgery, “Alma Mater Studiorum” University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy
  • Claudio Ricci Department of Surgery, “Alma Mater Studiorum” University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy
  • Raffaele Pezzilli Department of Internal Medicine, “Alma Mater Studiorum” University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy
  • Lucia Calculli Department of Radiology, “Alma Mater Studiorum” University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy
  • Marielda D’Ambra Department of Surgery, “Alma Mater Studiorum” University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy
  • Giovanni Taffurelli Department of Surgery, “Alma Mater Studiorum” University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy
  • Francesco Minni Department of Surgery, “Alma Mater Studiorum” University of di Bologna, S.Orsola-Malpighi Hospital. Bologna, Italy
DOI: https://doi.org/10.6092/1590-8577/3339
Keywords: Morbidity, Pancreas, Pancreatectomy

Abstract

Context The absence of a definition and a widely accepted ranking system to classify surgical complications has hampered proper interpretation of the surgical outcome. Patients Sixty-one patients undergoing distal pancreatectomy. Main outcome measures The complications were classified according to the Clavien-Dindo classification; each grade was evaluated regarding the length of the postoperative stay and was compared to the most important complications. Results Thirty (49.2%) patients had no complications; out of the thirty-one (50.8%) patients with complications, 9 (14.5%) had grade I, 15 (24.6%) had grade II, 6 (9.8%) had grade III, and 1 (1.6%) had grade IV. There were no postoperative deaths (grade V). A progressive increase in the length of hospitalization from patients with no complications to those having grade IV (P<0.001) was noted. Postoperative pancreatic fistula and postpancreatectomy hemorrhage rates did not significantly increase from Clavien-Dindo grade I to grade IV (P=0.118 and P=0.226, respectively). The severity of a postpancreatectomy hemorrhage, instead, was positively related to the grade of the Clavien-Dindo classification (P=0.049) while postoperative pancreatic fistula resulted near the significant value (P=0.058). Conclusions The Clavien-Dindo classification is a simple way of reporting all complications following distal pancreatectomy. It allows us to distinguish a normal postoperative course from any deviation and the severity of complications and it may be useful for comparing postoperative morbidity between different pancreatic centers.

Image: Relationship between the length of the postoperative stay and the Clavien-Dindo classification.

Downloads

Download data is not yet available.

References

van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 2005; 242:781-7. [PMID 16327488]

Simons JP, Shah SA, Ng SC, Whalen GF, Tseng JF. National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 2009; 13:1798-805. [PMID 19506975]

Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 2010; 34:121-5. [PMID 20020297]

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138:8-13. [PMID 16003309]

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142:20-5. [PMID 17629996]

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142:761-8. [PMID 17981197]

Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992; 111:518-26. [PMID 1598671]

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; 240:205-13. [PMID 15273542]

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250:187-96. [PMID 19638912]

Seeliger H, Christians S, Angele MK, Kleespies A, Eichhorn ME, Ischenko I, et al. Risk factors for surgical complications in distal pancreatectomy. Am J Surg 2010; 200:311-7. [PMID 20381788]

Relationship between the length of the postoperative stay and the Clavien-Dindo classification
Published
2011-03-09
How to Cite
CasadeiR., RicciC., PezzilliR., CalculliL., D’AmbraM., TaffurelliG., & MinniF. (2011). Assessment of Complications According to the Clavien-Dindo Classification After Distal Pancreatectomy. JOP. Journal of the Pancreas, 12(2), 126-130. https://doi.org/10.6092/1590-8577/3339
Issue
Vol 12 No 2 (2011): March - p. 78-215
Section
ORIGINAL ARTICLE

Copyright (c) 2011 Riccardo Casadei, Claudio Ricci, Raffaele Pezzilli, Lucia Calculli, Marielda D’Ambra, Giovanni Taffurelli, Francesco Minni

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.