“CLINICAL STUDY OF CLAVIEN-DINDO CLASSIFICATION TO ASSESS THE GRADES OF COMPLICATION AND FACTORS RESPONSIBLE IN CASES OF GASTROINTESTINAL PERFORATIONS IN A TERTIARY CARE CENTRE”

Abstract

INTRODUCTION Perforation peritonitis is one of the most common surgical emergencies across the globe. Gastrointestinal perforations have very high morbidity and mortality rates, irrespective of the type of operative procedure performed. The Clavien-Dindo system is nowadays widely used for complications after surgery for grading adverse events (i.e. complications) which occur as a result of surgical procedures and has become the standard classification system for many surgical specialties for open as well as laparoscopic surgeries . In this study, an attempt is made to find out various preoperative and intra operative factors that may responsible for adverse outcome and to identify the best management that could decrease the complication rate with special reference to CLAVIEN-DINDO classification. MATERIALS AND METHODS We did an observational study of 60 perforation peritonitis patients admitted in Department of Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, M.P. between November 2017 to May 2019(1 and 1/2 Year) on the basis of Clavien-Dindo classification.All were studied with respect to clinical features, time of presentation, comorbid conditions, investigations, intervention done, operative findings and postoperative course and all the data was entered in preformed proforma RESULTS Total 60 patients of perforation peritonitis admitted and treated in the department, During the period of November 2017 to May 2019. End of the study concludes the following points: • In my study, most of the cases were between age group 20-39(50%). more common in males 41 (68.33%). who presented after 3 days from onset of symptoms 20 (33.33%) all of them had complications 20(100%). P Value was<0.001 which is significant. In 16 (26.6%) patient’s comorbid conditions were present, out of them 12 (75%) patients were haemodynamically unstable and 9(56.25%) patient expired.In 29 (48.33%) patient size of perforation was more than 1 cm out of which complication observed in 28(96.55%) patient.. P Value was <0.001 which is significant. In 10 (16.66%) patients multiple perforations were found out of which 09 (90%) patients were unstable. Complication occurred in 09(90%) patients . In this group 6(60%) patient expired. P Value was 0.001 which is significant . In 24(40%) patients more than 500 ml intraperitoneal collection was found, out of which complications developed in all 24(100%) patients,. Chi Square Value was 42.8 and P Value was<0.001 which is significant. Complication according to clavien -dindo classification 14 out of 60 (23.33%) patients had no complications, 4 (6.66%) had grade I complication, 5 (8.33%) had grade II complications, 12 (20%) had grade III complications, 11 (18.33%) had grade IV complications, and 14 (23.33%) had grade V complication rates . CONCLUSION Post-operative complications increase due to comorbid conditions, size and number of perforations and it also affects the outcome of the patient. It is observed that with the increase in contamination (intraperitoneal collection) morbidity increases.For the classification of complications, a new system is proposed by Clavien–Dindo which is very helpful during perforation surgery, it is used in all over the world and facilitates in comparisons or evaluation of various surgical . The new classification mainly focuses on the medical perspective, with a major emphasis on the risk, type of anaesthesia and procedures or therapy used to correct a complication. We therefore recommend the use of clavien-dindo classification of complications.