discover clavien-dindo classification
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STARSurg DISCOVER 2014 Guide to Clavien-Dindo ClassificationTRANSCRIPT
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Clavien-Dindo Classification of Surgical Complications
Stephen Chapman
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• Measure of morbidity
• Any deviation from the normal postoperative course (grades I-V)
• Classification via therapeutic consequence
• Grade allocated to each complication identified
STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Definitions
IAny deviation from the normal postoperative course without the need for pharmacological treatment other than the “allowed therapeutic regimens”, or surgical, endoscopic and radiological interventions
IIRequiring pharmacological treatment with drugs beyond those allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.
III Requiring surgical, endoscopic or radiological intervention.
IVLife-threatening complication requiring critical care management; CNS complications including brain haemorrhage and ischemic stroke (excluding TIA), sub-arrachnoidal bleeding.
V Death of a patient
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
• Thirty-day complications Day of surgery (day 1) – day 30
• Categories:
• Cardiovascular• Metabolic• Neurological• Renal• Respiratory• Surgical• Miscellaneous
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Example 1: A 52 year old man underwent gastrectomy for malignancy. Six days post-operatively he had left sided facial and limb weakness. His CT head scan showed no acute changes. He was not thrombolysed.
Several hours later the weakness resolved spontaneously. A diagnosis of transient ischaemic attack was made and aspirin 75mg OD was
started.
Eligible? Classification?
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Example 2: A 65 year old man underwent elective left hepatectomy for
resection of hepatocellular carcinoma (HCC). Following surgery he experienced significant post-operative nausea and vomiting
(PONV). The symptoms settled with adequate anti-emetic therapy. He also developed a wound infection requiring
antibiotics according to local policy. Eligible?
Classification?
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Example 3: A 69 year old lady underwent laparoscopic cholecystectomy for cholecystitis. Shortly after the operation, she developed severe abdominal pain and fever. A bile leak was confirmed and fixed during emergency laparotomy. She recovered with no further
complications.
Eligible? Classification?
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Example 4: A 52 year old man underwent elective left hemicolectomy for malignancy. In the days following the procedure he developed
pneumonia and was started on empirical antibiotic therapy. His breathing continued to deteriorate, leading to critical care escalation with eventual ventilatory support. He recovered
following a prolonged stay in critical care.Eligible?
Classification?
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Example 5: A 59 year old man underwent living donor liver transplantation.
His post-operative course was uncomplicated, apart from moderate PONV requiring anti-emetic therapy.
Eligible? Classification?
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Eligible? Classification?
Example 6: A 41 year old lady underwent anterior resection for a rectal
tumour. On the first post-operative night he spiked a temperature and was given intravenous paracetamol. On day 2
he was hypokalaemic and was administered oral potassium supplementation.
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Eligible? Classification?
Example 7: A 61 year old man underwent femoral-popliteal bypass for
worsening arterial insufficiency. Post-operatively, he suffered an acute myocardial infarction leading to cardiac arrest.
Resuscitation attempts were unsuccessful and the patient was pronounced dead shortly after.
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STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England
Eligible? Classification?
Example 8: A 34 year old man underwent laparoscopic appendicectomy for
acute appendicitis. Post-operatively, he developed an intra-abdominal collection requiring drainage in theatre. Two days
later he developed a temperature. Nitrites were identified in his urine, following which antibiotics were commenced
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Take home points…
• Classification of morbidity via therapeutic consequence
• Primary outcome measure for the DISCOVER Audit
• Grade for each identified complication
• QUALITY ASSURANCE – Please complete online e-module prior to embarking on data collection!
STARSurgII : DISCOVER Protocol Launch16th September 2014, Royal College of Surgeons of England