Clavien-Dindo Classification of Surgical Complications
Internationally standardised grading system for postoperative complications from Grade I (minor deviation) to Grade V (death). Mandatory for surgical audit and research.
Score interpretation
Grade I: Allowed deviations from normal postoperative course. Bedside wound opening, antiemetics, antipyretics, physiotherapy.
→ Document in notes. Bedside wound management or physiotherapy if needed. Paracetamol for fever. No escalation required unless progresses. Record for audit.
Grade II: Complications requiring drug treatment beyond allowed grade I categories. E.g., UTI, pneumonia, anastomotic leak managed medically.
→ Initiate appropriate drug treatment (antibiotics, anticoagulants, TPN). Blood transfusion if required. Senior review. Document and escalate if not responding.
Grade IIIa/b: Surgical, endoscopic, or radiological intervention required.
→ IIIa: Interventional radiology (drain), bedside procedure, flexible endoscopy under local anaesthesia. IIIb: Return to theatre under GA for washout, re-anastomosis, or definitive repair. Anaesthetic review. Consent for re-operation. Inform patient and family.
Grade IVa/b: Life-threatening complication requiring ICU management.
→ Immediate ICU admission. Organ support as required. Critical care consultant review. MDT management. Inform next of kin. Surgical review daily. Consider palliative discussion if Grade IVb and not improving.
Grade V: Death of patient.
→ Complete death documentation. Duty of Candour — inform family. Morbidity and mortality (M&M) review. DATIX/critical incident reporting. Coroner referral if unexpected or procedure-related death. Offer bereavement support.
Interpretation bands for the Clavien-Dindo. Apply clinical judgement and local guidance.
References
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004.
- Clavien PA et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009.
Related
Curated clinical cross-links plus same-class fallbacks.
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Cefuroxime · Second-Generation Cephalosporin — Respiratory / Surgical Prophylaxis
- Cefazolin · First-Generation Cephalosporin (Surgical Prophylaxis)
- Cefazolin (Surgical Prophylaxis) · 1st Generation Cephalosporin (Surgical Antibiotic Prophylaxis)
- Tranexamic Acid (Surgical / Trauma Haemorrhage) · Antifibrinolytic (Haemostatic)
- Clindamycin (Surgical Prophylaxis — Penicillin Allergy) · Antibiotic (Lincosamide) — Surgical Prophylaxis
- Major Trauma — Primary Survey (ATLS) · ATLS 10th Edition; JRCALC; NICE NG39
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Burns — TBSA Estimation & Fluid Resuscitation · British Burn Association; EMSB; RCEM 2024
- Lower Gastrointestinal Bleed · NICE; BSG; ACPGBI — Commissioning Guide
- Acute Pancreatitis · NICE; IAP/APA; ACPGBI — CG104
- Hypertrophic Pyloric Stenosis · BAPS / RCPCH
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.