# Clavien-Dindo classification for assessment of complications after 1465 unselected otorhinolaryngology and head and neck surgeries in a university hospital: a retrospective observational study

## TL;DR

This study uses the Clavien-Dindo classification to assess surgical complications in over 1,400 head and neck surgeries, finding that smoking and certain procedures increase complication risks.

## Contribution

The study demonstrates the practicality of the Clavien-Dindo classification for standardizing complication assessment in otorhinolaryngology surgeries.

## Key findings

- 14.1% of surgeries had postoperative complications, primarily Clavien-Dindo grade II and III.
- Smoking was a significant predictor of postoperative complications (OR = 1.526).
- Esophageal surgery had the highest complication risk compared to other procedures.

## Abstract

Assessment of surgical complications is an important part of quality control on departments of otorhinolaryngology and head and neck surgery. Nevertheless, standardized assessment of surgical complications with easy-to-use instruments is not yet clinical routine.

Data from all 1,465 otorhinolaryngology and head and neck surgeries (male 60.3%; median age: 52 years) performed in 2020 at a department of otorhinolaryngology of a tertiary university hospital were analyzed. The postoperative complications were graded with the Clavien–Dindo classification (CDC).

The most frequent types of surgery were: diagnostic endoscopy (19.4%), ear surgery (14.8%) and oral/pharyngeal surgery (12.1%). Two-hundred seven patients (14.1%) had CDC complications, mostly CDC grade II (6.9%) and CDC grade III (5.1%). Due to multivariate analysis, smoking was an important predictor of postoperative CDC complication (Odds ratio [OR] = 1.526; confidence interval [CI] = 1.037 to 2.244). The risk of re-admission was higher for patients with postoperative complications (OR = 2.859; CI = 2.119 to 3.8591). Compared to a diagnostic endoscopy, the incidence of postoperative complications was highest for esophageal surgery (highest risk: OR = 23.580; CI = 7.619 to 72.978), thyroid surgery (second highest risk: OR = 21.060; CI = 4.838 to 91.665), and salivary gland surgery (OR = 15.330; CI = 5.215 to 45.070).

The CDC grading is a useful tool for grading all kind of otorhinolaryngology and head and neck surgery complications. CDC is well suited for comparing different types of otorhinolaryngology and head and neck surgeries with each other and also patients of different hospitals.

The online version contains supplementary material available at 10.1186/s12893-025-02970-1.