title: Assessment of the Clavien-Dindo classification system for complications in head and neck surgery.
abstract: OBJECTIVE
  The importance of reporting and grading surgical complications is central to quality improvement in head and neck surgery. The purpose of this study is to assess the interobserver reliability, content validity, and construct validity of the Clavien-Dindo classification system for use in grading complications related to head and neck surgery.
  
  
  METHODS
  1 and 2.
  
  
  METHODS
  Hypothetical cases of common head and neck surgical complications, along with a brief questionnaire, were responded to by 81 residents, fellows, and head and neck surgeons for grading to assess the interobserver reliability of the Clavien-Dindo system. Construct validity was assessed with the a priori hypothesis that increasing complication grade resulted in an increased length of hospital stay.
  
  
  RESULTS
  Interobserver reliability scores for the complication grading scenarios ranged mostly from moderate to high. The grading system was well received by the respondents, but specific concerns were raised regarding utility in head and neck surgery. Construct validity was confirmed as hospital length of stay was statistically related to complication grade (P = .002) CONCLUSION: Reporting of complications is critical to quality improvement in surgical practice. Currently, the Clavien-Dindo complication grading scale system is a useful tool for grading head and neck surgery complications; however, the development of a grading scale customized to head and neck surgery may be beneficial in the future.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Monteiro
authors.forename: Michael C
authors.initials: MC
authors.lastname: Sklar
authors.forename: Antoine
authors.initials: A
authors.lastname: Eskander
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.forename: Mark
authors.initials: M
authors.lastname: Shrime
authors.forename: Patrick
authors.initials: P
authors.lastname: Gullane
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: Ralph
authors.initials: R
authors.lastname: Gilbert
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.forename: Kevin
authors.initials: K
authors.lastname: Higgins
authors.forename: Danny
authors.initials: D
authors.lastname: Enepekides
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000145:classification*; D058996:Quality Improvement; D015203:Reproducibility of Results
keywords: Clavier classification; head and neck; quality improvement; surgical complications