The Clavien–Dindo Classification of Surgical Complications

According to Donabedian, medical quality is determined by structure, process and outcome. In surgery, outcome is still the most frequently used indicator of surgical quality. However, there is still a lack of a precise definition of a ‘good’ or ‘bad’ surgical outcome. In 1992, it was proposed that ‘negative outcome’ should be subdivided into complication, failure to cure and sequelae . Complications were defined as ‘any deviation from the normal postoperative course’. Conditions, which are inherent to the procedure and are expected to occur (such as pain or scar formation) should be discriminated from complications and be termed ‘sequelae’. Finally, diseases that remain unchanged after surgery or reoccur (e.g. R2-resected tumour or an early recurrence of an inguinal hernia) also reflect negative outcomes, either, but constitute a failure to cure rather than a complication.