A Novel Proposal for Classifying Pediatric Tonsillectomy Complications: Modified Clavien Classification

Purpose: A modified Clavien classification system has been proposed to grade perioperative complications. We share our experience in grading the complications of percutaneous nephrolithotomy (PNL), according to this new classification. Methods: A total of 809 PNLs performed between 2010 and 2014 were reviewed retrospectively. The modified Clavien classification system, which classifies the perioperative complications into 5 grades, was applied. Grade wise comparison of complications between the patients with simple and complex calculi was done. We also carried out a univariate analysis of different predictors of complications after surgery. Results: A total of 253 perioperative complications were observed in 237 (29.29%) patients. Most complications were related to bleeding and urinary leakage. Patients with complex calculi had significantly more number of complications across all Clavien groups. In a univariate analysis, positive preoperative urine culture and multiple access for stone clearance were identified to be the independent predictors of complications. Conclusion: The modified Clavien system is a simplistic grading system for classification of postoperative complications. However, it suffers from various shortcomings. Therefore, till the proposition of a more comprehensive classification system, the modified Clavien system is useful for reporting the complications and short-term outcomes of PNL.

Download Full-text

1047 Operative time is associated with perioperative TURB complications: A modified Clavien classification system analysis

European Urology Supplements ◽

10.1016/s1569-9056(12)61043-4 ◽

2012 ◽

Vol 11 (1) ◽

pp. e1047-e1047a

Author(s):

C. De Nunzio ◽

C. Leonardo ◽

L. Cindolo ◽

R. Autorino ◽

R. Miano ◽

...

Keyword(s):

Classification System ◽

System Analysis ◽

Operative Time ◽

Clavien Classification ◽

Clavien Classification System

Download Full-text

Clavien Classification of Semirigid Ureteroscopy Complications: A Prospective Study

Urology ◽

10.1016/j.urology.2012.05.047 ◽

2012 ◽

Vol 80 (5) ◽

pp. 995-1001 ◽

Cited By ~ 27

Author(s):

Swarnendu Mandal ◽

Apul Goel ◽

Manish Kumar Singh ◽

Rohit Kathpalia ◽

Deepak S. Nagathan ◽

...

Keyword(s):

Prospective Study ◽

Clavien Classification ◽

A Prospective Study

Download Full-text

Supracostal Approach for PCNL: Is 10th and 11th Intercostal Space Safe According to Clavien Classification System?

International Surgery ◽

10.9738/intsurg-d-13-00167.1 ◽

2014 ◽

Vol 99 (6) ◽

pp. 857-862 ◽

Cited By ~ 4

Author(s):

Cengiz Kara ◽

Tansu Değirmenci ◽

Zafer Kozacioglu ◽

Bulent Gunlusoy ◽

Omer Koras ◽

...

Keyword(s):

Shock Wave Lithotripsy ◽

Operative Time ◽

Intercostal Space ◽

Clavien Classification ◽

Stone Free Rate ◽

Grade Ii ◽

Clavien Classification System ◽

Group 2 ◽

Free Rate ◽

Group 1

Abstract The purpose of this study was to evaluate the success and morbidity of percutaneous nephrolithotomy (PCNL) performed through the 11th and 10th intercostal space. Between March 2005 and February 2012, 612 patients underwent PCNL, 243 of whom had a supracostal access. The interspace between the 11th and 12th rib was used in 204 cases (group 1) and between the 10th and 11th interspaces in 39 cases (group 2). PCNL was performed using standard supracostal technique in all patients. The operative time, success rate, hospital stay, and complications according to the modified Clavien classification were compared between group 1 and group 2. The stone-free rate was 86.8% in group 1 and 84.6% in group 2 after one session of PCNL. Auxiliary procedures consisting of ureterorenoscopy (URS) and shock wave lithotripsy (SWL) were required in 5 and 7 patients, respectively, in group 1; and in 1 patient each in group 2 . After the auxiliary procedures, stone-free rates increased to 92.6% in group 1 and 89.7% in group 2. A total of 74 (30.4%) complications were documented in the 2 groups according to modified Clavien classification. Grade-I complications were recorded in 20 (8.2%), grade-II in 38 (15.6%), grade-IIIa in 13 (5.3%), and grade-IIIb in 2 (0.8%) patients; grade-IVa was recorded in 1 (0.4%) patient. There were no grade-IVb or grade-V complications. Overall complication rate was 30.9% in group 1 and 28.2% in group 2. Supracostal PCNL in selected cases is effective and safe with acceptable complications. The modified Clavien system provides a standardized grading system for complications of PCNL.

Download Full-text

Re: Preoperative Risk Factors Predicting Complication Rates of Augmentation Cystoplasty Using the Modified Clavien Classification System in Pediatric Population

The Journal of Urology ◽

10.1097/01.ju.0000578892.80562.7a ◽

2019 ◽

Vol 202 (5) ◽

pp. 856-856

Author(s):

Douglas A. Canning

Keyword(s):

Risk Factors ◽

Classification System ◽

Pediatric Population ◽

Complication Rates ◽

Augmentation Cystoplasty ◽

Preoperative Risk ◽

Clavien Classification ◽

Preoperative Risk Factors ◽

Clavien Classification System

Download Full-text

Impact of Neoadjuvant Chemotherapy on Postoperative Morbidity after Gastrectomy for Gastric Cancer

Digestive Surgery ◽

10.1159/000381884 ◽

2015 ◽

Vol 32 (4) ◽

pp. 229-237 ◽

Cited By ~ 8

Author(s):

Patrick Téoule ◽

Jörg Trojan ◽

Wolf Bechstein ◽

Guido Woeste

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Postoperative Morbidity ◽

Locally Advanced ◽

Group Versus ◽

Wound Infection Rate ◽

Clavien Classification ◽

Cancer Of The Stomach ◽

Locally Advanced Gastric Cancer ◽

The Impact

Background/Aims: Patients with locally advanced gastric cancer benefit from neoadjuvant chemotherapy. Potential disadvantages of neoadjuvant chemotherapy include increased surgical complications, leading to increased postoperative morbidity. Methods: We retrospectively studied medical records of 135 patients with resectable cancer of the stomach who underwent gastrectomy between 2002 and 2009. The impact of neoadjuvant chemotherapy on postoperative morbidity was investigated. We compared demographic, clinical and operative data, morbidity and mortality from 105 patients who received surgical treatment immediately after diagnosis (SURG group), versus 30 patients who first received neoadjuvant chemotherapy (CHEMO group). Results: Demographic, clinical and surgical procedure parameters did not differ significantly between both groups. Postoperative morbidity was 46.7% in CHEMO- and 41.9% in SURG-patients (p = 0.680). There were eight cases of death, 2/30 (6.7%) in CHEMO and 6/105 (5.7%) in the SURG group (p = 1). The overall complications according to Clavien-classification did not differ significantly (p = 0.455). The wound infection rate (23.3 vs. 3.8%; p = 0.002) and insufficiency of the duodenal stump (13.3 vs. 1.9%; p = 0.022) were significantly higher in the CHEMO group. Conclusion: This study showed no significant impact of neoadjuvant chemotherapy on postoperative morbidity after gastrectomy using the Clavien-classification. Only an increase in wound infections in CHEMO compared with the SURG group were noted. Therefore, neoadjuvant chemotherapy can be considered safe and feasible.

Download Full-text