Impact and validation of the Clavien-Dindo classification for oncologic surgeries in a high-volume center in Latin America: A single-center retrospective study.

Abstract

e23249 Background: Although the Clavien-Dindo classification (CDC) has emerged as a tool for postsurgical complication assessment, its application in Latin American cancer institutions requires validation to ensure its relevance and reliability. We aim to report the outcomes among oncology patients and validate the use of CDC in our setting in order to optimize the quality of oncology care. Methods: We perform a retrospective study on surgical cancer patients treated at a high-volume cancer center in Lima, Peru (2018–2024). Data were extracted from health electronic records. The CDC was implemented in 2018. The primary endpoint was the rate of postoperative complications identified by the CDC, with secondary endpoints assessing CDC grades over time and its association with age. Poisson models and the likelihood ratio test were used to assess temporal trends. Results: A total of 18,135 oncologic surgery patients were identified, with 1,266 CDC reports recorded, ranging from Grade I to V. The median age at surgery was 66 years for all CDC reports, with age medians of 65, 73.5, and 80.5 years for grades III, IV, and V, respectively. Around 53% of the patient cohort were female. The overall postoperative complication rate identified by the CDC was 1.44%. The most common grade was CDC II (3.34%, range 2.66-3.88%), followed by CDC I (1.73%, range 0.07-6.47%), CDC III (1.32%, range 1.07-2.09%), CDC IV (0.57%, range 0.33-0.80%), and CDC V (0.24%, range 0.11-0.50%). CDC grades remained consistent over time. Abdominal surgery accounted for 40.69% of CDC reports. Conclusions: In our center, the implementation of CDC has positively impacted oncologic surgery by standardizing complication assessment. The consistency of CDC grading over time demonstrates its reliability as a quality control tool. A significant association was found between older age and higher CDC grades. Lower complication rates, likely attributed to specialized oncological care, highlight the importance of trained surgical oncologists. Further research is needed to assess CDC implementation in other Latin American settings. Percentage distribution of the Clavien-Dindo risk groups over time in a Peruvian center, 2018-2024. P-values were reflects whether the rates differ across time and were estimated comparing a null model with another adjusted for year of surgery using the likelihood ratio test. Clavien-Dindo n in 2018 (N=2510) % in 2018 n / N in 2019 (N=2974) % in 2019 n / N in 2020 (N=2303) % in 2020 n / N in 2021 (N=3003) % in 2021 n / N in 2022 (N=2634) % in 2022 n / N in 2023 (N=2714) % in 2023 n / N in 2024 (N=2397) % in 2024 P-value I 40 1.59 10 0.34 15 0.65 193 6.43 24 0.91 2 0.07 52 2.17 0.285 II 91 3.63 98 3.3 86 3.73 80 2.66 76 2.89 88 3.24 93 3.88 0.893 III 29 1.16 38 1.28 27 1.17 32 1.07 33 1.25 35 1.29 50 2.09 0.023 IV 19 0.76 14 0.47 13 0.56 10 0.33 21 0.8 14 0.52 8 0.33 0.257 V 7 0.28 15 0.5 3 0.13 6 0.2 3 0.11 6 0.22 5 0.21 0.084