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

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.


Riccardo Casadei, Claudio Ricci, Raffaele Pezzilli, Lucia Calculli, Marielda D'Ambra, Giovanni Taffurelli, Francesco Minni

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