The Postsurgical Clavien-Dindo Classification in Minor Surgery Can Improve Perception and Communication (Investigation on Blepharoplasty)

Abstract

The postsurgical Clavien-Dindo classification in minor surgery can improve perception and communication (Investigation on Blepharoplasty). Background: Minor surgery lacks a standardized postoperative complication classification. This leads to the presentation of inaccurate postsurgical complication rates and makes comparisons challenging, especially for patients seeking information. This study aims to evaluate a standardized five-step complication grading system (Clavien-Dindo Classification, CDC) on the example of blepharoplasty, which is the most performed minor aesthetic surgery worldwide. Methods: A retrospective observational exploratory study of patients (N = 344) who received a bilateral upper eyelid blepharoplasty under local anesthesia from the same surgical staff was performed. Data were retrieved from the electronic patient record: the CDC grading and the surgeon-reported complications (N = 128) at the first follow-up on day 7. In addition, a telephone survey with patients (N = 261) after 6 months was performed, which consisted of 7 complication-related yes/no questions. Results: Based on the CDC, 41.6% of patients were classified as having no complications, and 58.4% had one. Furthermore, 1 patient (0.3%) received a revision under general anesthesia (CDC IIIb), 18 patients (5.2%) were re-operated under local anesthesia (CDC IIIa), 23 patients (6.7%) required pharmacological intervention (CDC II), and 159 patients (46.2%) had a complication from the normal postoperative course and received supportive treatment (CDC I). Moreover, 90.5% of the mentioned complications accounted for Grade I and II; 94% of the patients subjectively experienced no complications; 51% of patients were pleased with the surgery even though a complication occurred according to the CDC; 34% of complications escaped the awareness of the surgeon. Conclusions: Grade I and II complications occurred frequently. Complications escaped the perception of the patients and surgeons. The classification identifies a wide variety of postsurgical complications and allows a standardized comparison in minor surgery objectively. Potential: The CDC in minor procedures can improve the (institutional) preoperative communication with patients regarding potential postoperative expectations. Furthermore, the classification can be a useful tool to detect complication-related costs, identify insurance-related requests, and support evidence in medicolegal disputes. The example of blepharoplasty can be translated to various other and even less invasive procedures.

Keywords: Clavien–Dindo Classification; aesthetic cosmetic facial plastic reconstructive surgery; blepharoplasty; complication; perception; satisfaction.

Figure 1

(A) Schematic upper eyelid blepharoplasty surgery, with an example of the surgical preoperative incision marking. (B) Result of postoperative complications if classified according to CDC. (C) Result of postoperative complications by CDC grading system (Grad I, II, IIIA, IIIB). (D) Result of frequencies of registered complications.

Figure 2

(A) Results of the patient`s satisfaction questionnaire (using a patient-reported outcome measure (PROM) survey questionnaire). (B) Result of the patients unsatisfaction with specific complications. (C) Result of explicitly recorded surgeons’ unsatisfaction on day 7, which were extracted from the patients who complained about any postoperative events after the surgery stated in the first follow-up to the surgeons.

Figure 3

(A,B) Result of patients’ and surgeons’ perception of the CD classified complications with stated (un-)satisfaction. Horizontal black thick lines in Graph (A,B) divided as followed: 0 (no complication), 1 and 2 (“mild/minor” complication) (Grad I and II), where conservative treatment was applied, and 3a and 3b (“major” complication) (Grad IIIa, IIIb), where a revision surgery was performed under local and general anesthesia. The color scale (vertically) in all Graphs (A–D) on the right side of the Graphs indicates the amount of the number of patients. (C,D) Results of the comparison of matching (dis-)agreements from both the patients’ (y-axis) and surgeons’ statements (x-axis) from the EPR, in case no complications occurred (C) and in case complications were classified (D).