Early experience with the Clavien–Dindo classification in a major trauma unit

Abstract

Background: The Clavien-Dindo system is an essential traditional approach for classifying surgical complications. This research primarily aimed to evaluate and assess the use of the Clavien-Dindo classification (CD classification) to classify complications and determine in-hospital mortality rates among patients admitted to a level one trauma facility in Johannesburg, South Africa.

Methods: Data were collected retrospectively over a period of two years. We excluded patients younger than 18 years and those with incomplete clinical records. Frequencies and percentages illustrated the distributions of categorical variables. The association of each continuous variable with the complications was evaluated using Pearson’s chi-square or Fisher’s exact test. A p < 0.05 was considered statistically significant.

Results: One hundred and ninety-six records of patients who developed complications were reviewed, representing a 6.3% complication rate among patients admitted to the unit during this study period, with 87.2% males and a median age of 32 years across both sex groups. Penetrating injuries accounted for 69.4% of the cases. Grade I complications (34.2%) were the most commonly reported. Wound infections had the highest reported incidence, representing 21% of the cases. Most complications, comprising 63.8%, were associated with surgical procedures across all types of CD grades. The overall mortality rate was 9.2% (grade V).

Conclusions: Through this early experience we were able to test and demonstrate the applicability of the CD classification system within a real-world trauma population. This approach provides a structured method for documenting adverse events and facilitates comparability across centres. This audit demonstrated a high grade I complication rate and additionally highlighted several other trends, such as the prevalence of penetrating injuries in South Africa, and the impact of surgical procedures as a primary predictor of complications.