Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA).
Br J Surg. 2023 Apr 12;110(5):576-583. doi: 10.1093/bjs/znad034.
Inconsistent definitions of complications and unexpected events have limited accurate analysis of surgical outcomes. Perioperative outcome classifications currently used for adult patients have limitations when used for children.
A multidisciplinary group of experts modified the Clavien-Dindo classification to increase its utility and accuracy in paediatric surgery cohorts. Organizational and management errors were considered in the novel Clavien-Madadi classification, which focuses on procedural invasiveness rather than anaesthetic management. Unexpected events were prospectively documented in a paediatric surgery cohort. Results of the Clavien-Dindo and Clavien-Madadi classifications were compared and correlated with procedure complexity.
Unexpected events were prospectively documented in a cohort of 17 502 children undergoing surgery between 2017 and 2021. The results of both classifications were highly correlated (ρ = 0.95), although the novel Clavien-Madadi classification identified 449 additional events (organizational and management errors) over the Clavien-Dindo classification, increasing the total number of events by 38 per cent (1605 versus 1158 events). The results of the novel system correlated significantly with the complexity of procedures in children (ρ = 0.756). Furthermore, grading of events > grade III according to the Clavien-Madadi classification showed a higher correlation with procedure complexity (ρ = 0.658) than the Clavien-Dindo classification (ρ = 0.198).
The Clavien-Madadi classification is a tool for the detection of surgical and non-medical errors in paediatric surgery populations. Further validation in paediatric surgery populations is required before widespread use.
并发症和意外事件的定义不一致，限制了对手术结果的准确分析。目前用于成年患者的围手术期结局分类在用于儿童时存在局限性。
一组多学科专家对 Clavien-Dindo 分类进行了修改，以提高其在儿科手术队列中的实用性和准确性。新的 Clavien-Madadi 分类考虑了组织和管理错误，其重点是手术的侵袭性，而不是麻醉管理。在儿科手术队列中前瞻性记录了意外事件。比较了 Clavien-Dindo 和 Clavien-Madadi 分类的结果，并与手术复杂性相关。
在 2017 年至 2021 年间接受手术的 17502 名儿童队列中前瞻性记录了意外事件。两种分类的结果高度相关（ρ=0.95），尽管新的 Clavien-Madadi 分类比 Clavien-Dindo 分类多识别出 449 个事件（组织和管理错误），总事件数增加了 38%（1605 比 1158 个事件）。新系统的结果与儿童手术的复杂性显著相关（ρ=0.756）。此外，根据 Clavien-Madadi 分类，事件>Ⅲ级的分级与手术复杂性的相关性更高（ρ=0.658），而 Clavien-Dindo 分类的相关性较低（ρ=0.198）。
Clavien-Madadi 分类是检测儿科手术人群中手术和非医疗错误的工具。在广泛使用之前，需要在儿科手术人群中进一步验证。
