In search of a single standardised system for reporting complications in craniofacial surgery: a comparison of three different classifications

Figures & data

Figure 1. Definition: national specialised medical care in Sweden.

Table 1. Presentation of diagnoses per procedure.

Type of procedure	1	2	3	4	5	6	7	8	Total
Sagittal synostosis	87	176	–	–	184	3	–	2	412
Metopic	135	–	–	–	90	9	–	–	234
Unicoronal	42	1	–	2	3	8	2	1	59
Bicoronal	6	–	–	1	6	6	–	–	19
Frontosphenoidal	4	–	–	–	–	2	–	–	6
Lambdoid	5	2	–	–	2	–	–	–	9
>1 suture closed, not bicoronal	30	4	–	–	18	1	–	–	53
Pansynostosis	2	–	–	–	–	–	–	–	2
Apert	20	–	6	–	16	3	2	–	47
Crouzon	17	3	7	1	14	4	3	1	50
Pfeiffer	3	–	–	–	3	1	–	–	7
Saethre-Chotzen	22	–	3	–	9	2	2	–	38
Muenke	16	1	–	–	12	2	–	–	31
Miscellaneous diagnoses	9	–	2	3	–	–	1	1	16
Total	398	187	18	7	357	41	10	5	1023

Table 2. The Clavien–Dindo classification of complications.

Grades	Definition
Grade I	Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, or radiological interventions. Allowed therapeutic regimens include drugs, such as antiemetics, antipyretics, analgesics, diuretics, and electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside.
Grade II	Complications requiring pharmacological treatment with drugs other than those allowed for Grade 1 complications. Blood transfusions and total parenteral nutrition are included.
Grade III	Complications requiring surgical, endoscopic or radiological intervention.
Grade IIIa	Complications requiring intervention not under general anaesthesia.
Grade IIIb	Complications requiring intervention under general anaesthesia.
Grade IV	Life-threatening complications (including CNS complications)^a requiring IC/ICU management.
Grade IVa	Complications involving single-organ dysfunction (including the necessity for dialysis).
Grade IVb	Complications involving multi-organ dysfunction.
Grade V	Patient death.

CNS: central nervous system; IC: intermediate care; ICU: intensive care unit; TIA: transient ischemic attack.

^a Brain haemorrhage, ischemic stroke, subarachnoid bleeding, but excluding TIA.

Table 3. Leeds classification of complications associated with craniosynostosis surgery.

Group		Description
0		Perioperative occurrences
	A	Excessive blood transfusion (>60 ml/kg)
	B	Significant anaesthetic instability or complications
	C	Unplanned surgical intervention during index admission
1		Inpatient complications
	A	Normal LOS (within 2 SD)
	B	Prolonged LOS (>2 SD)
	C	Exceptionally prolonged LOS (>2 weeks)
2		Outpatient complications not requiring re-admission
	A	≤30 days since discharge
	B	>30 days since discharge
3		Complications requiring re-admission
	A	Non-surgical ≤30 days since discharge
	B	Non-surgical >30 days since discharge
	C	Surgical ≤30 days since discharge
	D	Surgical >30 days since discharge
4		Unexpected long-term deficit
	A	Resolved by 6 months
	B	Present at 6 months
5		Mortality
	A	Inpatient or ≤30 days since discharge
	B	>30 days since discharge

LOS: length of stay; SD: standard deviation.

Table 4. Oxford protocol classification of complications associated with craniosynostosis surgery.

Group	Description
1	No delay in discharge, reoperation or long-term sequelae
2	Delay in discharge but no further operation required
3	Reoperation but no long-term sequelae
4	Unexpected long-term deficit or neurological impairment (permanent disability)
5	Mortality

Information provided by Mr. David Johnson, Oxford Craniofacial Unit.