Validation of the Clavien-Dindo classification in plastic surgical breast procedures: A lastic surgery-specific interpretation.

Purpose

To validate the Clavien-Dindo classification (CDC) in plastic surgical breast procedures and develop a plastic surgery-specific interpretation with additional suffixes to improve consistency and clinical relevance.

Methods

This study was conducted in four parts. Consecutive clinical series comprising 647 patients across four procedure groups were analyzed to identify classification challenges and assess construct validity through associations between CDC grade, length of hospital stay (LOS), and surgical complexity. Inter-rater reliability of the original CDC was evaluated using 35 clinical scenarios graded by five plastic surgeons. A plastic surgery-specific interpretation and suffixes were developed and subsequently tested through reassessment and a structured usability evaluation.

Results

In total, 202 complications were graded. Several recurring classification challenges, including seroma and hematoma management, donor-site complications, and the distinction between prophylactic and therapeutic treatments, were identified. LOS increased with higher CDC grade, with significantly longer hospitalization for Grade IIIb compared with Grade I (p = 0.021). Complication severity was associated with surgical complexity (p = 0.014). Inter-rater reliability for the original CDC was substantial (κ = 0.72) and improved to almost perfect with the revised interpretation (κ = 0.94) in a puposively selected subset of scenarios. The proposed suffixes enabled clinically relevant distinctions, including reconstructive failure and anatomical location of complications.

Conclusion

The CDC demonstrates satisfactory validity and reliability in plastic surgical breast procedures. A structured, plastic surgery-specific interpretation with suffixes improves consistency and clinical relevance while preserving compatibility with the original classification.