Audit and application of Clavien-Dindo classification to complications in a Major Trauma unit in Johannesburg: Our early experience

Purpose : The aim of this study was to audit, evaluate and apply the Clavien-Dindo classification (CD classification) to complications of patients who presented and were admitted to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), a major trauma unit in Johannesburg, South Africa. The CD classification is derived from five traditional grades. These are therapies used to adjust or correct a specific complication and rank a complication in an objective and reproducible manner. Methods : Data was collected retrospectively from 1 January 2018 to 31 December 2019. We excluded all patients under the age of 18 years and patients whose clinical records were incomplete or missing. This data was from hospital databases that included trauma Medibanks and CMJAH surgery Redcap. The data collected was documented on Excel spreadsheet for further analysis. Frequencies and percentages were used to describe distributions of categorical variables. The association between each continuous variable and complication was evaluated using the Pearson’s chi-square or Fisher’s exact test. Univariate logistic regression analysis evaluated the inherent nature of patient characteristics to predict the probability of developing a complication. A P-value < 0.05 was considered statistically significant. Statistical analysis was performed using STATA version 16 (College Station, Texas 77845 USA). Results : Hundred and ninety-six records met inclusion criteria, from which 87.2% were male. Their median age was 32 years. Complications were reported in 2.2% of the patients and the most frequent complication was wound infection 21%. Complications were related to a surgical procedure in 64.8% across all CD grades of complications, which was statistically significant (p-value 0.002). Overall, 34.18% of the patients had CD Grade 1 complications. The overall mortality was 9.2%. Conclusions : CD classification is an invaluable tool and we continue to apply it in our local practice to improve patient outcome and reduce the complication rates. Grade 1 complications were the most common in our study. Our audit revealed that the primary predictor for complications is related to surgical procedures across all grades. We found the application of the Clavien-Dindo classification to our complication rates allowed for better quantification of the morbidities seen in trauma, and enhanced our quality control measures.