Aug 2026· Frontiers in Veterinary Science· Vol 13· 0 citations· 21 references
Medicine
TL;DR
The hypothesis that the Cook and aCD grading systems would yield comparable postoperative complication rates was rejected, and a grading system with greater categorical resolution that distinguishes true complications from expected outcomes may provide a more clinically relevant assessment of postoperative risk.
Abstract
Introduction A standardized system for grading postoperative complications in veterinary orthopedics was proposed in 2010 by Cook et al. categorizing complications as minor, major, or catastrophic. Despite broad acceptance, complication rates still vary widely between studies. An alternative to the Cook system has been proposed; the adapted Clavien-Dindo (aCD) system, which categorizes five complication grades and distinguishes them from two other outcomes: ‘sequelae’ and ‘failures-to-cure’. The objective of this study was to compare postoperative complication rates in dogs undergoing tibial plateau leveling osteotomies (TPLO) using both systems. We hypothesized that there would be no significant difference in complication rates between grading systems. Methods Dogs undergoing TPLO between December 2023 and January 2025 were prospectively enrolled. Owner consent was obtained to review medical records and perform serial surveys for potential postoperative complications. A single investigator graded events with the Cook and aCD systems. Complication rates were compared with McNemar’s χ2 test (α < 0.05). Results Eighty-five TPLO procedures in 79 dogs were evaluated. Using the aCD system, the complication rate was 28.2% while the Cook system reported 54.1%. McNemar’s χ2 test showed a significant difference (p < 0.001) between systems. Twenty-six percent of Cook-classified complications were considered non-complications by the aCD system. Discussion We rejected our hypothesis that the Cook and aCD grading systems would yield comparable postoperative complication rates. The Cook system classified approximately twice the number of events as complications compared to the aCD system. A grading system with greater categorical resolution that distinguishes true complications from expected outcomes may provide a more clinically relevant assessment of postoperative risk.
The utility of the mCDS system for grading complications of EOS casting is assessed and it is hypothesized that, with modifications, it would be a valid system for assessing these complications.
Elinor Stern, Elizabeth Kappler, Makayla Hart et al.· Journal of pediatric orthope...· 0 citations
Background: Total Knee Arthroplasty (TKA) is a widely performed procedure for end-stage knee disorders, but
postoperative complications can affect functional outcomes and patient satisfaction.
Aim: To evaluate ‘
the incidence, type, severity, timing, and outcomes of complications following TKA over the
past year.
Methodology: A prospective observational study was conducted on 80 patients aged 40–80 years undergoing
primary TKA at Shankar Chikitsalaya. Patients were followed for 6 months postoperatively, and complications
were classified by type, severity, and onset. Statistical analysis was performed using descriptive and inferential
methods.
Results: Of 80 patients, 53.8% experienced no complications. Joint stiffness (15%), wound infection (10%), and
hematoma formation (7.5%) were the most common. Complications were mild in 48.8%, moderate in 36.6%, and
severe in 14.6% of cases. Early (0–2 weeks), intermediate (2–6 weeks), and late (6 weeks–6 months)
complications occurred in 24.4%, 36.6%, and 39% of patients, respectively. Conservative management was
sufficient in 53.7% of cases, while surgical intervention was required in 19.5%. Full recovery was achieved in
68.3% of patients, partial recovery in 24.4%, and persistent complications remained in 7.3%.
Conclusion: TKA is generally safe and effective, with most complications being mild and manageable. Extended
postoperative monitoring and individualized rehabilitation are essential to optimize outcomes.
S. Sinha, Kanishka Shankar· International Journal of Pha...· 0 citations
INTRODUCTION
Osteochondral allograft (OCA) transplantation can be performed through an open or arthroscopic approach, yet comparative data on early safety are scarce. This study compares 30-day complications after open versus arthroscopic knee OCA using a national database and identifies independent risk factors for adverse events.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing elective knee OCA procedures from 2010 to 2023. Adults with complete perioperative data were included. One-to-one nearest-neighbor propensity score matching was used to control for baseline differences between cohorts. Of 2087 cases meeting inclusion criteria, 2078 (1165 open, 913 arthroscopic) remained after 9 patients with concurrent billing for both codes were excluded, and 1826 of these patients were included in the final propensity-matched analysis (913 per group). Thirty-day complications, defined by any adverse event (AAE) and resource-utilization metrics, were compared with Wilcoxon rank-sum or chi-square testing. Separate multivariable logistic regressions identified predictors of AAE within each cohort.
RESULTS
Two thousand seventy-eight patients were initially identified, with 1165 (56%) undergoing open OCA and 913 (44%) undergoing arthroscopic OCA. After matching, 913 patients remained in each group. Open surgery was associated with a longer mean operative time (124.9 min vs.101.9 min, p < 0.001; median [IQR] 108 [77-152] vs.90 [61-126] minutes) and a greater mean length of stay (0.60 days vs.0.28 days, p < 0.001; median [IQR] 0 [0-1] vs.0 [0-0] days), differences that probably reflected the fact that larger or more complex lesions were more often treated with the open approach, as was the case for the greater overall burden of concomitant procedures, rather than being attributable to the approach itself. Open OCA was also associated with higher odds of overnight hospital admission compared with arthroscopic OCA (OR 2.99, 95% CI 2.34-3.81, p < 0.001). Thirty-day AAE rates were similarly low between cohorts (2.3% for open vs 2.2% for arthroscopic). No deaths, myocardial infarctions, strokes, or pneumonia occurred. Rates of individual complications (surgical-site infection, thromboembolism, transfusion, unplanned reoperation) were <1% with no between-group differences.
DISCUSSION & CONCLUSION
Knee OCA transplantation is exceptionally safe in the early postoperative period, with complication rates below 3% and no statistically significant difference in complications between open and arthroscopic techniques. Open procedures are associated with greater resource utilization, specifically longer operative time and length of stay, most likely reflecting their use for larger or anatomically complex lesions rather than an inherent difference in safety between approaches. In the open cohort, smoking is the principal modifiable risk factor for short-term morbidity and should be a focus of perioperative optimization. These findings support selecting surgical approaches based on lesion size, location, and technical considerations rather than concerns about early complications.
Sashrik Sribhashyam, Andrew K Chow, Robert S. Chin et al.· Knee (Oxford)· 0 citations
The standardized reporting of postoperative complications is essential for improving surgical quality and comparing outcomes. However, spinal surgery has historically lacked a universal system and has instead relied on ambiguous terms. This narrative review synthesizes the literature on the adaptation, validation, and application of the therapy-based Clavien-Dindo classification (CDC) and its modified versions in spinal surgery. It focuses on studies across various spinal procedures and patient populations. The evidence shows that adapted CDC systems demonstrate good to excellent inter- and intrarater reliability, particularly for severe complications. These systems also facilitate direct comparison of surgical techniques. Moreover, they reveal strong correlations between complication severity, prolonged hospital stay, and patient factors such as frailty. Nevertheless, key limitations include poor correlation with certain long-term patient-reported outcomes. The CDC cannot capture intraoperative events or the cumulative burden of multiple complications. Subjectivity also exists in grading milder events. Recent spine-specific modifications that improve neurologic deficit assessment have enhanced clinical relevance. Overall, the CDC provides a critical framework for standardizing complication reporting in spinal surgery. Optimal application requires awareness of its limitations. In complex scenarios, the CDC may be applied most effectively as a component within more comprehensive, spine-specific taxonomies that incorporate surgical complexity and structured neurological assessment. The CDC remains a vital tool for improving communication, benchmarking, and ultimately enhancing patient care.
Zhidi Lin, Kaiwen Chen, Chi Sun et al.· Spine Research· 0 citations
Background Access to primary total knee arthroplasty (TKA) for morbidly obese (MO) patients is often restricted to reduce complications. We compared complication rates in patients who were MO or non-MO (NMO) at initial presentation based on whether their body mass index (BMI) had decreased by ≥5%, remained stable, or increased by ≥5% at the time of surgery, hypothesizing that preoperative weight loss does not reduce complication rates. Methods Prospectively collected data for 2219 unilateral, primary TKAs were retrospectively reviewed. Cases were performed between 2012 and 2023 at the same academic center by 4 fellowship-trained surgeons using standardized protocols. Twenty-eight percent (n = 627) were MO and 72% (n = 1592) were NMO at initial presentation. Outcomes included intraoperative and 90-day complications and reoperations. Outcome covariates included patient demographics and comorbidities, as well as operative details. Independent samples t-tests and chi-squared tests were used for statistical analysis. Results Intraoperative complications (P = .999), medical complications (P ≥ .398), death (P = .299), superficial or deep infection (P = .731), and reoperation on the index joint within 90 days of surgery (P = .801) did not differ in MO patients with a ≥5% decrease vs stable BMI before surgery. These outcomes also did not differ between NMO patients with a ≥5% decrease in BMI and those with stable BMI before surgery (P ≥ .250). Conclusions Findings suggest that withholding surgery from patients who are clinically indicated for TKA pending weight loss may not be necessary to reduce early postoperative complications.
John P. Lewis, M. Ziemba-Davis, Leonard T. Buller et al.· Arthroplasty Today· 0 citations
As robotic platforms become increasingly adopted across colorectal and general surgical pathways, it is essential to understand their effect on postoperative morbidity. The Clavien–Dindo (CD) classification provides a validated framework for comparing complication severity. This study analysed complication rates and CD profiles following robotic and laparoscopic gastrointestinal procedures at a UK tertiary centre.
A retrospective-review of all robotic and laparoscopic procedures performed between 2024–2025 was undertaken. Procedures included colorectal resections, small-bowel operations, hernia repairs, adhesiolysis, and stoma surgery. Complications and their corresponding CD categories were extracted from postoperative documentation.
Comparisons between approaches used:Chi-square or Fisher’s exact test for overall complication rates, depending on frequency.Ordinal logistic regression to compare CD severity (I–V).Mann–Whitney U tests for length of stay (LOS).Binary logistic regression for predictors of any complication.
Complications occurred across both groups, including ileus, infection, bleeding, electrolyte imbalance, wound issues, and pulmonary events.
CD I–II complications predominated in both cohorts. CD-III events requiring intervention—including returns to theatre or radiological drainage—were observed at similar proportions. CD-IV complications (e.g., sepsis requiring organ support) occurred infrequently in both groups. Readmissions were comparable, typically for ileus or postoperative infection. Statistical-testing demonstrated no-significant difference in overall complication rates, CD category distribution, or LOS between robotic and laparoscopic procedures (all p > 0.05).
Robotic surgery did not demonstrate reduced postoperative-morbidity or CD-severity compared with laparoscopy. Complication severity appeared primarily driven by patient factors and case complexity. Larger, procedure-specific studies are warranted.
Mohammed Arifuzaman· British Journal of Surgery· 0 citations