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. 2020 Nov 22;9(11):3770.
doi: 10.3390/jcm9113770.

Modified Clavien-Dindo Classification and Outcome Prediction in Free Flap Reconstruction among Patients with Head and Neck Cancer

Wei-Ling Jan  1 , Hung-Chi Chen  2   3 , Chang-Cheng Chang  3   4   5 , Hsin-Han Chen  3 , Pin-Keng Shih  3 , Tsung-Chun Huang  3
Affiliations

Modified Clavien-Dindo Classification and Outcome Prediction in Free Flap Reconstruction among Patients with Head and Neck Cancer

Wei-Ling Jan et al. J Clin Med. .

Abstract

Because of limitations caused by unique complications of free flap reconstruction, the Clavien-Dindo classification was modified to include grade "IIIc" for "partial or total free flap failure." From 2013 to 2018, 116 patients who had undergone free flap reconstruction for head and neck cancer with grade III or higher postoperative complications were grouped using the "Modified" Clavien-Dindo classification. Alcoholism displayed significant predictive effects between grade IIIb and IIIc (72.7% vs. 50%, p = 0.028). Significant differences were observed between grade IIIb and IIIc in the duration of hospital stay (23.1 ± 10.1 vs. 28.6 ± 11.9 days, p = 0.015), duration of intensive care unit stay (6.0 ± 3.4 vs. 8.7 ± 4.3 days, p = 0.001), reoperation times during the current hospitalization (1.4 ± 0.8 vs. 2.0 ± 1.0 times, p < 0.001), and wound infection rate (29.9% vs. 62.5%, p = 0.002). The severity levels were significantly positively correlated with reoperation times during the current hospitalization (p < 0.001), ICU stay (p = 0.001), and hospital stay (p < 0.001). The modified Clavien-Dindo classification with grade IIIc describes the perioperative complications of head and neck free flap reconstruction to predict clinical outcomes based on severity.

Keywords: Clavien–Dindo classification; free flap reconstruction; head and neck cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient enrollment.
Figure 2
Figure 2
The Box-Whisker plot of factors associated with the severity level from grade IIIa to grade IVa, including the duration of intensive care unit stay (A), duration of hospital stay (B), percentage of wound infection (C), and the number of reoperations during the current hospitalization (D). All four factors exhibited a rising trend from grade IIIb to grade IIIc, which represented an increasing severity level of post-operative complications. The error bar represents the standard error.
See this image and copyright information in PMC

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