The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience
Abstract
In Brief Background and Aims: The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the complication. The principle of the classification was to be simple, reproducible, flexible, and applicable irrespective of the cultural background. The aim of the current study was to critically evaluate this classification from the perspective of its use in the literature, by assessing interobserver variability in grading complex complication scenarios and to correlate the classification grades with patients', nurses', and doctors’ perception. Material and Methods: Reports from the literature using the classification system were systematically analyzed. Next, 11 scenarios illustrating difficult cases were prepared to develop a consensus on how to rank the various complications. Third, 7 centers from different continents, having routinely used the classification, independently assessed the 11 scenarios. An agreement analysis was performed to test the accuracy and reliability of the classification. Finally, the perception of the severity was tested in patients, nurses, and physicians by presenting 30 scenarios, each illustrating a specific grade of complication. Results: We noted a dramatic increase in the use of the classification in many fields of surgery. About half of the studies used the contracted form, whereas the rest used the full range of grading. Two-thirds of the publications avoided subjective terms such as minor or major complications. The study of 11 difficult cases among various centers revealed a high degree of agreement in identifying and ranking complications (89% agreement), and enabled a better definition of unclear situations. Each grade of complications significantly correlated with the perception by patients, nurses, and physicians (P < 0.05, Kruskal-Wallis test). Conclusions: This 5-year evaluation provides strong evidence that the classification is valid and applicable worldwide in many fields of surgery. No modification in the general principle of classification is warranted in view of the use in ongoing publications and trials. Subjective, inaccurate, or confusing terms such as “minor or major” should be removed from the surgical literature. A critical appraisal 5 years after introducing a new system to rank postoperative complications has shown a rapid and wide acceptance in the literature. To further support the use of this system, we documented an excellent correlation between the various grades of severity and perception by patients and health care providers, and obtained consensus among experts to rank difficult cases. The grades are sufficiently self explanatory that subjective terms such as minor and major complications should be avoided.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Outcome measures were minor and major complications according to the Clavien-Dindo classification, as well as the need for revision surgery including recurrences requiring revision surgery.
“Outcome measures were minor and major complications according to Clavien and Dindo classification [7], as well as the need for revision surgery, including recurrences requiring revision surgery.”
From Otoplasty through Ventral Skin Incision and Shaping of the Antihelix by Abrasion—A Retrospective Study (2021) · cites this paper as [7]
Postoperative complications were categorized according to the Clavien-Dindo surgical complication grading scale.
“Postoperative complications were categorized according to the Clavien–Dindo surgical complication grading scale [14].”
From Composite Failure Associated With Sacrohysteropexy and Sacrocolpopexy With Supracervical Hysterectomy for Advanced Pelvic Organ Prolapse (2025) · cites this paper as [14]
The primary outcome was immediate postoperative moderate to severe adverse events assessed according to the Clavien-Dindo Severity Classification (Grade ≥ II).
“The primary outcome was immediate postoperative moderate to severe adverse events assessed according to the Clavien-Dindo Severity Classification (Grade ≥ II).”
The Clavien-Dindo classification is a widely adopted and validated system for grading the severity of complications.
“This classification is a widely adopted and validated system that grades the severity of complications based on the type of therapeutic intervention required.”
From Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression (2025) · cites this paper as [19]
The Clavien-Dindo classification was used for postoperative complications.
“Clavien–Dindo classification,19”
From Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area (2021) · cites this paper as [19]
Cites
Dindo, D., Demartines, N., & Clavien, P.-A. (2004) · Annals of Surgery · doi:10.1097/01.sla.0000133083.54934.ae · Cited by 31,378 · see citing works
Self-citationA surgical safety checklist to reduce morbidity and mortality in a global population
Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A.-H. S., Dellinger, E. P., Herbosa, T., Joseph, S., Kibatala, P. L., Lapitan, M. C. M., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmsa0810119 · Cited by 5,688 · see citing works
Hospital Volume and Surgical Mortality in the United States
Birkmeyer, J. D., Siewers, A. E., Finlayson, E. V. A., Stukel, T. A., Lucas, F. L., Batista, I., Welch, H. G., & Wennberg, D. E. (2002) · New England Journal of Medicine · doi:10.1056/nejmsa012337 · Cited by 5,001 · see citing works
Postoperative pancreatic fistula: An international study group (ISGPF) definition
Bassi, C., Dervenis, C., Butturini, G., Fingerhut, A. L., Yeo, C. J., Izbicki, J. R., Neoptolemos, J. P., Sarr, M. G., Traverso, W. L., & Büchler, M. W. (2005) · Surgery · doi:10.1016/j.surg.2005.05.001 · Cited by 4,280 · see citing works
Self-citationSurgeon Volume and Operative Mortality in the United States
Birkmeyer, J. D., Stukel, T. A., Siewers, A. E., Goodney, P. P., Wennberg, D. E., & Lucas, F. L. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa035205 · Cited by 3,109 · see citing works
Wente, M. N., Bassi, C., Dervenis, C., Fingerhut, A. L., Gouma, D. J., Izbicki, J. R., Neoptolemos, J. P., Padbury, R. T. A., Sarr, M. G., Traverso, L. W., et al. (2007) · Surgery · doi:10.1016/j.surg.2007.05.005 · Cited by 3,065 · see citing works
Self-citationWente, M. N., Veit, J. A., Bassi, C., Dervenis, C., Fingerhut, A. L., Gouma, D. J., Izbicki, J. R., Neoptolemos, J. P., Padbury, R. T. A., Sarr, M. G., et al. (2007) · Surgery · doi:10.1016/j.surg.2007.02.001 · Cited by 2,630 · see citing works
Self-citationProposed classification of complications of surgery with examples of utility in cholecystectomy.
Clavien, P., Sanabria, J. R., & Strasberg, S. M. (1992) · PubMed · Cited by 1,629 · see citing works
Self-citationSurgeon volume and operative mortality in the United States
Birkmeyer, J. D., Stukel, T. A., Siewers, A. E., Goodney, P. P., Wennberg, D. E., & Lucas, F. L. (2004) · ACC Current Journal Review · doi:10.1016/j.accreview.2003.12.065 · Cited by 1,113 · see citing works
The incidence and nature of surgical adverse events in Colorado and Utah in 1992
Gawande, A. A., Thomas, E. J., Zinner, M. J., & Brennan, T. A. (1999) · Surgery · doi:10.1067/msy.1999.98664 · Cited by 977 · see citing works
Assessment of Complications After Pancreatic Surgery
DeOliveira, M. L., Winter, J. M., Schäfer, M., et al. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000246856.03918.9a · Cited by 806 · see citing works
Self-citationHepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy
Mullen, J. T., Ribero, D., Reddy, S. K., Donadon, M., Zorzi, D., Gautam, S., Abdalla, E. K., Curley, S. A., Capussotti, L., Clary, B. M., et al. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2006.12.032 · Cited by 660 · see citing works
Self-citationBonvalot, S., Rivoire, M. L., Castaing, M., Stoeckle, E., Cesne, A. L., Blay, J., & Laplanche, A. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2008.18.0802 · Cited by 644 · see citing works
Quality of Complication Reporting in the Surgical Literature
Martin, R. C. G., Brennan, M. F., & Jaques, D. P. (2002) · Annals of Surgery · doi:10.1097/00000658-200206000-00007 · Cited by 620 · see citing works
Surgical research or comic opera: questions, but few answers
Horton, R. (1996) · The Lancet · doi:10.1016/s0140-6736(96)90137-3 · Cited by 582 · see citing works
Noblett, S. E., Snowden, C. P., Shenton, B. K., & Horgan, A. F. (2006) · British journal of surgery · doi:10.1002/bjs.5454 · Cited by 518 · see citing works
Ribero, D., Abdalla, E. K., Madoff, D. C., et al. (2007) · British journal of surgery · doi:10.1002/bjs.5836 · Cited by 509 · see citing works
Burch Colposuspension versus Fascial Sling to Reduce Urinary Stress Incontinence
Albo, M., Richter, H. E., Brubaker, L. T., Norton, P., Kraus, S. R., Zimmern, P. E., Chai, T. C., Zyczynski, H. M., Diokno, A. C., Tennstedt, S. L., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa070416 · Cited by 501 · see citing works
TEFEKLİ, A. H., Karadağ, M. A., Tepeler, K., et al. (2007) · European Urology · doi:10.1016/j.eururo.2007.06.049 · Cited by 477 · see citing works
Nakano, H., Oussoultzoglou, É., Rosso, E., Casnedi, S., Chenard, M., Dufour, P., Bachellier, P., & Jaeck, D. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e31815774de · Cited by 448 · see citing works
Donor Morbidity After Living Donation for Liver Transplantation
Ghobrial, R. M., Freise, C. E., Trotter, J. F., Tong, L., OJO, A. O., Fair, J. H., Fisher, R. A., Emond, J. C., Koffron, A. J., Pruett, T. L., et al. (2008) · Gastroenterology · doi:10.1053/j.gastro.2008.04.018 · Cited by 437 · see citing works
Reddy, S. K., Pawlik, T. M., Zorzi, D., et al. (2007) · Annals of Surgical Oncology · doi:10.1245/s10434-007-9522-5 · Cited by 423 · see citing works
R1 Resection by Necessity for Colorectal Liver Metastases
de Haas, R. J., Wicherts, D. A., Flores-Villalba, E. A., Azoulay, D., Castaing, D., & Adam, R. A. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e31818a07f1 · Cited by 423 · see citing works
Barr, M. L., Belghiti, J., Villamil, F. G., et al. (2006) · Transplantation · doi:10.1097/01.tp.0000216825.56841.cd · Cited by 368 · see citing works
A Fast-Track Program Reduces Complications and Length of Hospital Stay After Open Colonic Surgery
Müller, S., Zalunardo, M. P., Hübner, M., Clavien, P., & Demartines, N. (2009) · Gastroenterology · doi:10.1053/j.gastro.2008.10.030 · Cited by 360 · see citing works
Self-citationHwang, S., Lee, S., Lee, Y. J., et al. (2006) · Liver Transplantation · doi:10.1002/lt.20734 · Cited by 352 · see citing works
Clavien, P., Camargo, C. A., Croxford, R., et al. (1994) · Annals of Surgery · doi:10.1097/00000658-199408000-00002 · Cited by 337 · see citing works
Self-citationLong-Term Results of Two-Stage Hepatectomy for Irresectable Colorectal Cancer Liver Metastases
Wicherts, D. A., Miller, R., de Haas, R. J., et al. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e3181907fd9 · Cited by 331 · see citing works
DeMatteo, R. P., Maki, R. G., Singer, S., et al. (2007) · Annals of Surgery · doi:10.1097/01.sla.0000236630.93587.59 · Cited by 314 · see citing works
Hepatic Steatosis Is a Risk Factor for Postoperative Complications After Major Hepatectomy
McCormack, L., Petrowsky, H., Jochum, W., Furrer, K., & Clavien, P. (2007) · Annals of Surgery · doi:10.1097/01.sla.0000251747.80025.b7 · Cited by 309 · see citing works
Self-citationHow Should Transection of the Liver Be Performed?
Lesurtel, M., Selzner, M., Petrowsky, H., et al. (2005) · Annals of Surgery · doi:10.1097/01.sla.0000189121.35617.d7 · Cited by 297 · see citing works
Goh, B. K. P. (2008) · Archives of Surgery · doi:10.1001/archsurg.143.10.956 · Cited by 263 · see citing works
Beck‐Schimmer, B., Breitenstein, S., Urech, S., et al. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e31818f3dda · Cited by 253 · see citing works
Complications of 2,775 Urological Laparoscopic Procedures: 1993 to 2005
Permpongkosol, S., Link, R. E., Su, L.-M., et al. (2007) · The Journal of Urology · doi:10.1016/j.juro.2006.09.031 · Cited by 246 · see citing works
Results of laparoscopic sleeve gastrectomy: A prospective study in 135 patients with morbid obesity
Fuks, D., Verhaeghe, P. J., Bréhant, O., et al. (2008) · Surgery · doi:10.1016/j.surg.2008.07.013 · Cited by 245 · see citing works
Strasberg, S. M., Linehan, D. C., & Hawkins, W. G. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2006.11.002 · Cited by 244 · see citing works
Belli, G., Fantini, C., D’Agostino, A., et al. (2007) · Surgical Endoscopy · doi:10.1007/s00464-007-9503-6 · Cited by 238 · see citing works
Muscari, F., Suc, B., Kirzin, S., et al. (2006) · Surgery · doi:10.1016/j.surg.2005.08.012 · Cited by 234 · see citing works
Petrowsky, H., McCormack, L., Trujillo, M., et al. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000246834.07130.5d · Cited by 214 · see citing works
Standards for Surgical Complication Reporting in Urologic Oncology: Time for a Change
Donat, S. M. (2007) · Urology · doi:10.1016/j.urology.2006.09.056 · Cited by 207 · see citing works
Fatal and Nonfatal Hemorrhagic Complications of Living Kidney Donation
Friedman, A. L., Peters, T. G., Jones, K. W., et al. (2005) · Annals of Surgery · doi:10.1097/01.sla.0000193841.43474.ec · Cited by 191 · see citing works
de Reuver, P. R., Grossmann, I., Busch, O. R., et al. (2007) · Annals of Surgery · doi:10.1097/01.sla.0000252442.91839.44 · Cited by 177 · see citing works
Reddy, S. K., Morse, M. A., Hurwitz, H. I., Bendell, J. C., Gan, T. J., Hill, S. E., & Clary, B. M. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2007.06.290 · Cited by 172 · see citing works
D'Angelica, M. I., Kornprat, P., Gönen, M., Chung, K.-Y. Y., Jarnagin, W. R., DeMatteo, R. P., Fong, Y., Kemeny, N. E., Blumgart, L. H., & Saltz, L. B. (2006) · Annals of Surgical Oncology · doi:10.1245/s10434-006-9074-0 · Cited by 168 · see citing works
Heinrich, S., Schäfer, M., Weber, A., Hany, T. F., Bhure, U., Pestalozzi, B. C., & Clavien, P. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e318190a6da · Cited by 164 · see citing works
Self-citationPancreatic Resection of Isolated Metastases from Nonpancreatic Primary Cancers
Reddy, S., Edil, B. H., Cameron, J. L., et al. (2008) · Annals of Surgical Oncology · doi:10.1245/s10434-008-0140-7 · Cited by 160 · see citing works
Self-citationPrevention and treatment of complications following percutaneous nephrolithotomy
Skolarikos, A. A., & de la Rosette, J. J. M. C. H. (2008) · Current Opinion in Urology · doi:10.1097/mou.0b013e3282f46afc · Cited by 156 · see citing works
Lermite, É., Pessaux, P., Bréhant, O., et al. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2007.01.018 · Cited by 155 · see citing works
Rozet, F., Jaffe, J. S., Braud, G., et al. (2007) · The Journal of Urology · doi:10.1016/j.juro.2007.03.111 · Cited by 154 · see citing works
Chun, Y. S., Vauthey, J., Ribero, D., et al. (2007) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0272-2 · Cited by 150 · see citing works
Self-citationElias, D. M., Goèré, D., Pietrantonio, D. D., et al. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e31815f0113 · Cited by 150 · see citing works
Zorzi, D., Chun, Y. S., Madoff, D. C., Abdalla, E. K., & Vauthey, J. (2008) · Annals of Surgical Oncology · doi:10.1245/s10434-008-0035-7 · Cited by 144 · see citing works
Self-citationPercutaneous and Laparoscopic Cryoablation of Small Renal Masses
Finley, D. S., Beck, S. M., Box, G. N., Chu, W., Deane, L. A., Vajgrt, D. J., McDougall, E. M., & Clayman, R. V. (2008) · The Journal of Urology · doi:10.1016/j.juro.2008.04.019 · Cited by 138 · see citing works
de la Rosette, J. J. M. C. H., Zuazu, J. R., Tsakiris, P., et al. (2008) · The Journal of Urology · doi:10.1016/j.juro.2008.08.025 · Cited by 135 · see citing works
Zullo, M. A., Plotti, F., Calcagno, M., et al. (2006) · European Urology · doi:10.1016/j.eururo.2006.10.066 · Cited by 132 · see citing works
Long-term wound advantages of the laparoscopic approach in rectal cancer
Laurent, A., Leblanc, F., Bretagnol, F., et al. (2008) · British journal of surgery · doi:10.1002/bjs.6134 · Cited by 130 · see citing works
Elias, D. M., Honoré, C., Ciuchendea, R., et al. (2008) · British journal of surgery · doi:10.1002/bjs.6235 · Cited by 129 · see citing works
Chan, S. C., Fan, S. T., Lo, C. M., et al. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000225085.82193.08 · Cited by 125 · see citing works
Laparoscopic approach in surgical treatment of rectal cancer
Laurent, A., Leblanc, F., Gineste, C., et al. (2007) · British journal of surgery · doi:10.1002/bjs.5884 · Cited by 123 · see citing works
CLASSIFICATION AND TRENDS OF PERIOPERATIVE MORBIDITIES FOLLOWING LAPAROSCOPIC RADICAL PROSTATECTOMY
Gonzalgo, M. L., Pavlovich, C. P., Trock, B. J., Link, R. E., Sullivan, W., & Su, L.-M. (2005) · The Journal of Urology · doi:10.1097/01.ju.0000161607.04334.26 · Cited by 116 · see citing works
Long-term Outcomes in Laparoscopic vs Open Ventral Hernia Repair
Bingener, J. (2007) · Archives of Surgery · doi:10.1001/archsurg.142.6.562 · Cited by 116 · see citing works
A Prospective Evaluation of Laparoscopic Versus Open Left Lateral Hepatic Sectionectomy
Aldrighetti, L. A., Pulitanò, C., Catena, M., et al. (2007) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0244-6 · Cited by 114 · see citing works
Three-Quarters of Right Liver Donors Experienced Postoperative Complications† ‡
Yi, N., Suh, K., Cho, J. Y., et al. (2007) · Liver Transplantation · doi:10.1002/lt.21030 · Cited by 111 · see citing works
Vanounou, T., Pratt, W. B., Fischer, J. E., et al. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2007.01.025 · Cited by 111 · see citing works
Yi, N., Suh, K., Lee, H. W., et al. (2007) · Liver Transplantation · doi:10.1002/lt.21213 · Cited by 108 · see citing works
Proposed classification of complications after live donor nephrectomy
Koçak, B., Koffron, A. J., Baker, T., et al. (2006) · Urology · doi:10.1016/j.urology.2005.11.023 · Cited by 98 · see citing works
Patel, S. A., Orloff, M., Tsoulfas, G., et al. (2007) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2007.01938.x · Cited by 97 · see citing works
Recording and Classification of Complications in a Surgical Practice
Veen, J.-W. H. P. L. M. R. (1999) · The European Journal of Surgery · doi:10.1080/110241599750006622 · Cited by 91 · see citing works
Does the Surgical Apgar Score Measure Intraoperative Performance?
Regenbogen, S., Lancaster, R., Lipsitz, S., Greenberg, C., Hutter, M., & Gawande, A. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e318181c6b1 · Cited by 90 · see citing works
POSSUM accurately predicts morbidity for pancreatic resection
Pratt, W. B., Joseph, S., Callery, M. P., et al. (2007) · Surgery · doi:10.1016/j.surg.2007.07.035 · Cited by 89 · see citing works
Surgical Management of Early-Stage Hepatocellular Carcinoma: Resection or Transplantation?
Bellavance, E. C., Lumpkins, K. M., Mentha, G., et al. (2008) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-008-0652-2 · Cited by 84 · see citing works
Pessaux, P., Regimbeau, J.-M., Dondero, F., et al. (2007) · British journal of surgery · doi:10.1002/bjs.5728 · Cited by 84 · see citing works
Current trends in live liver donation
Nadalin, S., Malagó, M., Radtke, A., et al. (2006) · Transplant International · doi:10.1111/j.1432-2277.2006.00424.x · Cited by 82 · see citing works
Liver Transplantation: The Last Measure in the Treatment of Bile Duct Injuries
de Santibáñes, E., Ardiles, V., Gadano, A. C., et al. (2008) · World Journal of Surgery · doi:10.1007/s00268-008-9650-5 · Cited by 78 · see citing works
Schiesser, M., Chen, J. W. C., Maddern, G. J., et al. (2007) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0438-y · Cited by 78 · see citing works
Hepatic Resection is Justified for Elderly Patients with Hepatocellular Carcinoma
Kondo, K., Chijiiwa, K., Funagayama, M., et al. (2008) · World Journal of Surgery · doi:10.1007/s00268-008-9688-4 · Cited by 76 · see citing works
Strasberg, S. M., Linehan, D. C., Clavien, P., et al. (2007) · Surgery · doi:10.1016/j.surg.2006.12.001 · Cited by 76 · see citing works
Self-citationBreitenstein, S., Kraus, A., Hahnloser, D., et al. (2007) · World Journal of Surgery · doi:10.1007/s00268-007-9199-8 · Cited by 76 · see citing works
Impact of clinical pathways in surgery
Müller, M. K., Dedes, K. J., Dindo, D. R., et al. (2008) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-008-0352-0 · Cited by 76 · see citing works
Self-citationJaffe, J. S., Stakhovsky, O., Cathelineau, X., et al. (2007) · The Journal of Urology · doi:10.1016/j.juro.2007.03.114 · Cited by 76 · see citing works
Lelong, B., Bège, T., Esterni, B., et al. (2006) · Diseases of the Colon & Rectum · doi:10.1007/s10350-006-0751-7 · Cited by 74 · see citing works
No mortality after 150 consecutive pancreatoduodenctomies with duct‐to‐mucosa pancreaticogastrostomy
Murakami, Y., Uemura, K., Hayashidani, Y., et al. (2007) · Journal of Surgical Oncology · doi:10.1002/jso.20903 · Cited by 74 · see citing works
Patel, S. A., Cassuto, J. R., Orloff, M. S., et al. (2008) · Transplantation · doi:10.1097/tp.0b013e3181643ce8 · Cited by 73 · see citing works
Constantinides, C. A., Tyritzis, S. Ι., Skolarikos, A. A., et al. (2008) · British Journal of Urology · doi:10.1111/j.1464-410x.2008.08080.x · Cited by 73 · see citing works
Oulhaci, W. (2007) · Swiss Medical Weekly · doi:10.4414/smw.2007.11796 · Cited by 72 · see citing works
Third Prize: Randomized Trial of Laparoscopic Donor Nephrectomy with and without Hand Assistance
Bargman, V., Sundaram, C. P., Bernie, J., et al. (2006) · Journal of Endourology · doi:10.1089/end.2006.20.717 · Cited by 72 · see citing works
Effect of a Continuous Peripheral Nerve Block on the Inflammatory Response in Knee Arthroplasty
Bagry, H., DELACUADRAFONTAINE, J., Asenjo, J. F., et al. (2007) · Regional Anesthesia & Pain Medicine · doi:10.1016/j.rapm.2007.06.398 · Cited by 72 · see citing works
Shen, P., Thai, K., Stewart, J. H., Howerton, R. M., Loggie, B. W., Russell, G. B., & Levine, E. A. (2008) · Annals of Surgical Oncology · doi:10.1245/s10434-008-0127-4 · Cited by 71 · see citing works
Goeman, L., Salomon, L., TAILLE, A. D. L., Vordos, D., Hoznek, A., Yiou, R., & Abbou, C. C. (2006) · World Journal of Urology · doi:10.1007/s00345-006-0054-6 · Cited by 70 · see citing works
Live Donor Liver Transplantation in Adults
Fan, S. T. (2006) · Transplantation · doi:10.1097/01.tp.0000235171.17287.f2 · Cited by 69 · see citing works
Wolff, B. G., Weese, J. L., LUDWIG, K. A., et al. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2007.01.041 · Cited by 66 · see citing works
Hübner, M., Demartines, N., Müller, S., et al. (2008) · British journal of surgery · doi:10.1002/bjs.6321 · Cited by 66 · see citing works
Effect of a Continuous Peripheral Nerve Block on the Inflammatory Response in Knee Arthroplasty
Bagry, H., Fontaine, J. C. D. L. C., Asenjo, J. F., et al. (2008) · Regional Anesthesia & Pain Medicine · doi:10.1097/00115550-200801000-00004 · Cited by 66 · see citing works
Quality Assessment in High-Acuity Surgery
Vollmer, C. M. (2007) · Archives of Surgery · doi:10.1001/archsurg.142.4.371 · Cited by 65 · see citing works
Sundaram, C. P., Martin, G. L., Guise, A. I., et al. (2007) · Surgical Endoscopy · doi:10.1007/s00464-006-9176-6 · Cited by 62 · see citing works
Long-term follow-up after combined fissurectomy and Botox injection for chronic anal fissures
Scholz, T., Hetzer, F. H., Dindo, D. R., et al. (2007) · International Journal of Colorectal Disease · doi:10.1007/s00384-006-0261-z · Cited by 60 · see citing works
Self-citationSystematic grading of surgical complications in live liver donors according to Clavien's system
Tamura, S., Sugawara, Y., Kaneko, J., et al. (2006) · Transplant International · doi:10.1111/j.1432-2277.2006.00375.x · Cited by 60 · see citing works
Laparoscopic Treatment for Intrahepatic Duct Stones in the Era of Laparoscopy
Yoon, Y., Han, H., Shin, S. H., et al. (2009) · Annals of Surgery · doi:10.1097/sla.0b013e31818eea56 · Cited by 59 · see citing works
Lermite, É., Pessaux, P., Teyssedou, C., et al. (2008) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.03.016 · Cited by 57 · see citing works
Complexity- and risk-adjusted model for measuring surgical outcome
Pillai, S. B., van Rij, A. M., Williams, S., Thomson, I. A., Putterill, M. J., & Greig, S. (1999) · British journal of surgery · doi:10.1046/j.1365-2168.1999.01286.x · Cited by 57 · see citing works
Classifying Surgical Complications
Veen, E. J. (2005) · Archives of Surgery · doi:10.1001/archsurg.140.11.1078 · Cited by 55 · see citing works
Pomposelli, J. J., Gupta, S. K., Zacharoulis, D. C., et al. (1997) · Journal of Vascular Surgery · doi:10.1016/s0741-5214(97)70124-1 · Cited by 54 · see citing works
Porpiglia, F., Terrone, C., Tarabuzzi, R., et al. (2006) · Urology · doi:10.1016/j.urology.2006.02.039 · Cited by 54 · see citing works
Vanounou, T., Pratt, W. B., Callery, M. P., et al. (2007) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2007.05.011 · Cited by 49 · see citing works
Morbidity and Mortality Following Multivisceral Resections in Complex Hepatic and Pancreatic Surgery
McKay, A. M., Sutherland, F. R., Bathe, O. F., et al. (2007) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0273-1 · Cited by 45 · see citing works
Antonacci, A. C., Lam, S., Lavarias, V., et al. (2008) · Journal of Surgical Research · doi:10.1016/j.jss.2008.02.054 · Cited by 45 · see citing works
Refining the Selection Criteria for Laparoscopic Versus Open Splenectomy for Splenomegaly
Feldman, L. S., Demyttenaere, S. V., Polyhronopoulos, G. N., et al. (2008) · Journal of Laparoendoscopic & Advanced Surgical Techniques · doi:10.1089/lap.2007.0050 · Cited by 45 · see citing works
Laparoscopic vs. Open Resection of Noninvasive Intraductal Pancreatic Mucinous Neoplasms
GUMBS, A., Grès, P., Madureira, F. A. V., & Gayet, B. (2008) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0311-z · Cited by 44 · see citing works
Vascular reconstruction with the superficial femoral vein following major oncologic resection
McKay, A. M., Motamedi, M., TEMPLE, W. J., et al. (2007) · Journal of Surgical Oncology · doi:10.1002/jso.20788 · Cited by 41 · see citing works
Historical perspective of living donor liver transplantation
Chan, S. C., & Fan, S. T. (2008) · World Journal of Gastroenterology · doi:10.3748/wjg.14.15 · Cited by 38 · see citing works
Ko, E., Castle, E. P., Desai, P. J., et al. (2008) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2008.07.013 · Cited by 37 · see citing works
de Rougemont, O., Dutkowski, P., Weber, M., et al. (2008) · Liver Transplantation · doi:10.1002/lt.21676 · Cited by 36 · see citing works
Stolzenburg, J., Rabenalt, R., Do, M., Lee, B., Truß, M. C., Schwaibold, H. E., Burchardt, M., Udo Jonas, A., & LIATSIKOS, E. N. (2006) · World Journal of Urology · doi:10.1007/s00345-005-0036-0 · Cited by 35 · see citing works
Yi, N., Suh, K., Cho, Y. B., Lee, H. W., Cho, E., Cho, J. Y., Shin, W. Y., Kim, J., & Lee, K. U. (2008) · World Journal of Surgery · doi:10.1007/s00268-008-9641-6 · Cited by 34 · see citing works
Alveolar-Membrane Diffusing Capacity Improves in the Morbidly Obese after Bariatric Surgery
Zavorsky, G. S., Kim, D. J., Sylvestre, J.-L., et al. (2008) · Obesity Surgery · doi:10.1007/s11695-007-9294-9 · Cited by 34 · see citing works
Does surgeon fatigue influence outcomes after anterior resection for rectal cancer?
Schieman, C., MacLean, A. R., Buie, W. D., et al. (2008) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2008.01.009 · Cited by 33 · see citing works
Neto, J. S., de Godoy, A. L., Carone, E., et al. (2008) · Transplantation · doi:10.1097/tp.0b013e318183ed22 · Cited by 32 · see citing works
Gumbs, A. A., Grès, P., Madureira, F. A. V., et al. (2008) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-007-0255-5 · Cited by 32 · see citing works
A Prospective Evaluation of Ultrasonic Dissector plus Harmonic Scalpel in Liver Resection
Arru, M., Pulitanò, C., Aldrighetti, L. A., et al. (2007) · The American Surgeon · doi:10.1177/000313480707300312 · Cited by 32 · see citing works
Hübner, M., Hahnloser, D., Hetzer, F. H., et al. (2007) · Surgical Endoscopy · doi:10.1007/s00464-006-9034-6 · Cited by 26 · see citing works
Testicular Pain Following Laparoscopic Renal Surgery
Gjertson, C. K., & Sundaram, C. P. (2008) · The Journal of Urology · doi:10.1016/j.juro.2008.07.045 · Cited by 26 · see citing works
Living donor liver transplantation for fulminant hepatic failure
Matsui, Y., Sugawara, Y., Yamashiki, N., Kaneko, J., Tamura, S., Togashi, J., Makuuchi, M., & Kokudo, N. (2008) · Hepatology Research · doi:10.1111/j.1872-034x.2008.00372.x · Cited by 25 · see citing works
Self-citationRight Hepatectomy for Living Liver Donation vs Right Hepatectomy for Disease
Gali, B. (2007) · Archives of Surgery · doi:10.1001/archsurg.142.5.467 · Cited by 25 · see citing works
Donor evaluation and hepatectomy for living-donor liver transplantation
Tamura, S., Sugawara, Y., & Kokudo, N. (2008) · Journal of Hepato-Biliary-Pancreatic Surgery · doi:10.1007/s00534-007-1294-6 · Cited by 24 · see citing works
Retroperitoneoscopy: A Versatile Access for Many Urologic Indications
Teber, D., TEFEKLİ, A. H., Eskiçorapçı, S., et al. (2006) · European Urology Supplements · doi:10.1016/j.eursup.2006.07.012 · Cited by 21 · see citing works
Donor Outcome After Living Liver Donation: A Single-Center Experience
Khalaf, H., Al-Sofayan, M., Elsheikh, Y., et al. (2007) · Transplantation Proceedings · doi:10.1016/j.transproceed.2007.03.003 · Cited by 21 · see citing works
Biliary complications in right lateral sector graft live donor liver transplantation
Kyoden, Y., Tamura, S., Sugawara, Y., et al. (2008) · Transplant International · doi:10.1111/j.1432-2277.2007.00613.x · Cited by 18 · see citing works
Hepatectomy using traditional Péan clamp–crushing technique under intermittent Pringle maneuver
Ishizaki, Y., Yoshimoto, J., Sugo, H., et al. (2008) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.09.046 · Cited by 16 · see citing works
Extended left‐sided pancreatectomy with spleen preservation
Mohebati, A., & Schwarz, R. E. (2007) · Journal of Surgical Oncology · doi:10.1002/jso.20940 · Cited by 15 · see citing works
Predictors of adverse surgical outcome in the management of malignant bowel obstruction.
Medina‐Franco, H., García-Álvarez, M. N., Ortíz-López, L. J., et al. (2008) · PubMed · Cited by 15 · see citing works
Alperin, M., Sutkin, G., Ellison, R., Meyn, L. A., Moalli, P., & Zyczynki, H. (2008) · International Urogynecology Journal · doi:10.1007/s00192-008-0704-x · Cited by 14 · see citing works
Bergman, S., Feldman, L. S., Anidjar, M., et al. (2008) · PubMed · Cited by 14 · see citing works
Zullo, M. A., Ruggiero, A., Plotti, F., et al. (2008) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2008.03.014 · Cited by 13 · see citing works
Proposed Live Donor Nephrectomy Complication Classification Scheme
Tan, H. P., Shapiro, R., Montgomery, R. A., et al. (2006) · Transplantation · doi:10.1097/01.tp.0000202730.42368.fa · Cited by 13 · see citing works
Leandros, E., Alexakis, N., Albanopoulos, K., Dardamanis, D., Karagiorga, M., Gomatos, I. P., Papadopoulos, S. G., Bacoyiannis, C., & Bramis, J. (2006) · World Journal of Surgery · doi:10.1007/s00268-005-0542-7 · Cited by 11 · see citing works
Systematic Grading of Surgical Complications in Live Liver Donors†
Sugawara, Y., Tamura, S., & Makuuchi, M. (2007) · Liver Transplantation · doi:10.1002/lt.21064 · Cited by 11 · see citing works
Self-citationLucidi, V., Lemyé, A.-C., Baire, L., et al. (2007) · Transplantation Proceedings · doi:10.1016/j.transproceed.2007.08.004 · Cited by 10 · see citing works
Systematic Grading of Morbidity After Living Donation for Liver Transplantation
Tamura, S., Sugawara, Y., Kukudo, N., et al. (2008) · Gastroenterology · doi:10.1053/j.gastro.2008.09.050 · Cited by 9 · see citing works
Laparoscopic live donor nephrectomy: The pediatric recipient in a dual‐site program
Bergman, S., Feifer, A. H., Feldman, L. S., et al. (2007) · Pediatric Transplantation · doi:10.1111/j.1399-3046.2006.00664.x · Cited by 8 · see citing works
LAPAROSCOPIC ASSISTED COLECTOMY: EXPERIENCE FROM A RURAL CENTRE
Guo, D., Eteuati, J., Nguyen, M. H., et al. (2007) · ANZ Journal of Surgery · doi:10.1111/j.1445-2197.2007.04034.x · Cited by 6 · see citing works
Pay for performance: what the urogynecologist should know
Erekson, E. A., Sung, V. W., & Myers, D. L. (2008) · International Urogynecology Journal · doi:10.1007/s00192-008-0627-6 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Groot, V. P., Rezaee, N., Wu, W., Cameron, J. L., Fishman, E. K., Hruban, R. H., Weiss, M. J., Zheng, L., Wolfgang, C. L., & He, J. (2018) · Annals of Surgery · doi:10.1097/sla.0000000000002234 · Cited by 757 · see citing works
Self-citationAbu Dayyeh, B. K., Bazerbachi, F., Vargas, E. J., Sharaiha, R. Z., Thompson, C. C., Thaemert, B. C., Teixeira, A. F., Chapman, C. G., Kumbhari, V., Ujiki, M. B., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01280-6 · Cited by 338 · see citing works
Kamarajah, S. K., Bundred, J., & Tan, B. H. L. (2019) · Gastric Cancer · doi:10.1007/s10120-018-0882-2 · Cited by 259 · see citing works
Boone, B. A., Bahary, N., Zureikat, A. H., Moser, A. J., Normolle, D. P., Wu, W.-C., Singhi, A. D., Bao, P., Bartlett, D. L., Liotta, L. A., et al. (2015) · Annals of Surgical Oncology · doi:10.1245/s10434-015-4566-4 · Cited by 234 · see citing works
Gemenetzis, G., Bagante, F., Griffin, J. F., Rezaee, N., Javed, A. A., Manos, L. L., Lennon, A. M., Wood, L. D., Hruban, R. H., Zheng, L., et al. (2017) · Annals of Surgery · doi:10.1097/sla.0000000000001988 · Cited by 127 · see citing works
Self-citationKamarajah, S. K., Bundred, J., Weblin, J., & Tan, B. H. L. (2020) · Surgery · doi:10.1016/j.surg.2019.07.032 · Cited by 126 · see citing works
Spivak, H., Abdelmelek, M. F., Beltran, O. R., Ng, A. W., & Kitahama, S. (2012) · Surgical Endoscopy · doi:10.1007/s00464-011-2125-z · Cited by 115 · see citing works
Laparoscopic versus abdominal sacrocolpopexy: a randomized controlled trial
Costantini, E., Mearini, L., Lazzeri, M., Bini, V., Nunzi, E., di Biase, M., & Porena, M. (2016) · Journal of Urology · doi:10.1016/j.juro.2015.12.089 · Cited by 108 · see citing works
Consoli, M. L. D., da Silva, R. S., Nicoli, J. R., Bruña‐Romero, O., da Silva, R. G., de Vasconcelos Generoso, S., & Correia, M. I. T. D. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115584387 · Cited by 93 · see citing works
Risk factors for postoperative pneumonia after gastrectomy for gastric cancer
Miki, Y., Makuuchi, R., Tokunaga, M., Tanizawa, Y., Bando, E., Kawamura, T., & Terashima, M. (2016) · Surgery Today · doi:10.1007/s00595-015-1201-8 · Cited by 77 · see citing works
Semaglutide vs endoscopic sleeve gastroplasty for weight loss
Haseeb, M., Chhatwal, J., Xiao, J., Jirapinyo, P., & Thompson, C. C. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.6221 · Cited by 73 · see citing works
Toozs‐Hobson, P., Freeman, R., Barber, M., Maher, C., Haylen, B., Athanasiou, S., Swift, S., Whitmore, K., Ghoniem, G., & de Ridder, D. (2012) · Neurourology and Urodynamics · doi:10.1002/nau.22238 · Cited by 70 · see citing works
Outcomes after rectosigmoid resection for endometriosis: a systematic literature review
Balla, A., Quaresima, S., Subiela, J. D., Shalaby, M., Petrella, G., & Sileri, P. (2018) · International Journal of Colorectal Disease · doi:10.1007/s00384-018-3082-y · Cited by 61 · see citing works
Veit-Rubin, N., Dubuisson, J.-B., Lange, S., Eperon, I., & Dubuisson, J. (2016) · International Urogynecology Journal · doi:10.1007/s00192-015-2859-6 · Cited by 59 · see citing works
Matthews, C. A., Geller, E. J., Henley, B. R., Kenton, K., Myers, E. M., Dieter, A. A., Parnell, B., Lewicky-Gaupp, C., Mueller, M. G., & Wu, J. M. (2020) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000003884 · Cited by 51 · see citing works
Leenen, J. P. L., Ardesch, V., Kalkman, C. J., Schoonhoven, L., & Patijn, G. A. (2024) · BJS Open · doi:10.1093/bjsopen/zrad128 · Cited by 36 · see citing works
Kamarajah, S. K., Gudiozzi, N., Findlay, J. M., Lee, M. J., Pinkney, T., & Markar, S. R. (2025) · eClinicalMedicine · doi:10.1016/j.eclinm.2025.103408 · Cited by 29 · see citing works
Clinical outcomes following surgical management of deep infiltrating endometriosis
Leborne, P., Huberlant, S., Masia, F., de Tayrac, R., Letouzey, V., & Allegre, L. (2022) · Scientific Reports · doi:10.1038/s41598-022-25751-9 · Cited by 26 · see citing works
Hudelist, G., Pashkunova, D., Darici, E., Rath, A., Mitrowitz, J., Dauser, B., Senft, B., & Bokor, A. (2023) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14676 · Cited by 23 · see citing works
Kedestig, J., & Stenberg, E. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.03.010 · Cited by 23 · see citing works
Long-Term Oncologic Outcomes, Opioid Use, and Complications after Esophageal Cancer Surgery
Oh, T. K., Kim, K., Jheon, S. H., Do, S.-H., Hwang, J.-W., Jeon, Y.-T., Kim, K., & Song, I.-A. (2018) · Journal of Clinical Medicine · doi:10.3390/jcm7020033 · Cited by 20 · see citing works
Hiltunen, J., Eloranta, M.-L., Lindgren, A., Keski-Nisula, L., Anttila, M., & Sallinen, H. (2021) · Journal of International Medical Research · doi:10.1177/03000605211032788 · Cited by 15 · see citing works
Venkatraman, V., Kirsch, E. P., Luo, E., Kunte, S., Ponder, M., Gellad, Z. F., Liu, B., Lee, H.-J., Jung, S.-H., Haglund, M. M., et al. (2022) · JMIR Perioperative Medicine · doi:10.2196/38690 · Cited by 13 · see citing works
Junrungsee, S., Vipudhamorn, W., Lapisatepun, W., Thepbunchonchai, A., Chotirosniramit, A., Lapisatepun, W., & Ko-iam, W. (2025) · Surgery · doi:10.1016/j.surg.2025.109351 · Cited by 13 · see citing works
Kühn, S., Wöhler, N., Wehle, A., Küenzlen, L., Rothenberger, J., Sader, R., Lemperle, G., & Rieger, U. M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10163713 · Cited by 7 · see citing works
“Table 1 outlines complications requiring revision surgery, classified as Clavien–Dindo Grade III [7].”
BackgroundMethodInfluentialSato, H., Otsuka, S., Sugita, K., Abe, H., & Tsukada, S. (2025) · Neurourology and Urodynamics · doi:10.1002/nau.25640 · Cited by 2 · see citing works
Erekson, E., Menefee, S. A., Whitworth, R., Gizlice, S., Zyczynski, H. M., Rahn, D. D., Amundsen, C. L., Sung, V. W., Arya, L. A., Ferrando, C. A., et al. (2026) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2025.11.002
- Authors
- Clavien, P. A., Barkun, J., de Oliveira, M. L., Vauthey, J. N., Dindo, D., Schulick, R. D., de Santibañes, E., Pekolj, J., Slankamenac, K., Bassi, C., Graf, R., Vonlanthen, R., Padbury, R., Cameron, J. L., & Makuuchi, M.
- Affiliations
- University Hospital Zurich (CH)
- McGill University (CA)
- The University of Texas MD Anderson Cancer Center (US)
- Johns Hopkins University (US)
- Hospital Italiano de Buenos Aires (AR)
- Flinders Medical Centre (AU)
- Corresponding author
- Clavien, Pierre A.
- Dindo, Daniel
- Slankamenac, Ksenija
- Graf, Rolf
- Vonlanthen, René
- Padbury, Robert
- ORCID
- Venue
- Annals of Surgery
- Published
- 2009-08
- Volume
- 250
- Issue
- 2
- Pages
- 187-196
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2144173184
- Cited by
- 11,482
- References
- 141
- Citations by year
- 2026: 939 · 2025: 1187 · 2024: 1237 · 2023: 1210 · 2022: 1208 · 2021: 1086 · 2020: 934 · 2019: 701 · 2018: 600 · 2017: 502 · 2016: 514 · 2015: 445 · 2014: 318 · 2013: 242 · 2012: 169
- FWCI
- 74.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- Clavien-Dindo classification, postoperative complications, complication grading, interobserver agreement, complication severity, patient perspectives, nurses' perceptions, physician perceptions, classification validity
- MeSH terms
- Attitude of Health Personnel, Humans, Terminology as Topic, Postoperative Complications, Retrospective Studies, Severity of Illness Index, Reproducibility of Results, Observer Variation, Patient Satisfaction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
