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Grading of Surgical Complications

The Clavien-Dindo system , originally described in 2004, is widely used throughout surgery for grading adverse events (i.e. complications) which occur as a result of surgical procedures;  it is now used in most urology units and has become the standard classification system for many surgical specialties.  Details of the grading system are shown below:

Grade I Any deviation from the normal post-operative course not requiring surgical, endoscopic or radiological intervention. This includes the need for certain drugs (e.g. antiemetics, antipyretics, analgesics, diuretics and electrolytes), treatment with physiotherapy and wound infections that are opened at the bedside
Grade II Complications requiring drug treatments other than those allowed for Grade I complications; this includes blood transfusion and total parenteral nutrition (TPN)
Grade III Complications requiring surgical, endoscopic or radiological intervention
       Grade IIIa - intervention not under general anaesthetic
       Grade IIIb - intervention under general anaesthetic
Grade IV Life-threatening complications; this includes CNS complications (e.g. brain haemorrhage, ischaemic stroke, subarachnoid haemorrhage) which require intensive care, but excludes transient ischaemic attacks (TIAs)
       Grade IVa - single-organ dysfunction (including dialysis)
       Grade IVb - multi-organ dysfuncton
Grade V Death of the patient

Disability after discharge from hospital

If a patient continues to suffer from a complication at the time of discharge, the suffix “d” (for disability) is added to the respective grade of complication. This indicates that a full and careful follow-up is required to complete evaluation of the adverse event. This sub-classification is sometimes used by individual units but is not routinely recorded in the BAUS datasets.

Clavien-Dindo Templates

Click on the icon to download the template you require: ZIP files require "unzipping" before they can be used: