ArticleThe British journal of surgery2023
Implementation and validation of a novel instrument for the grading of unexpected events in paediatric surgery: Clavien-Madadi classification.
Article in The British journal of surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.
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Who cites it
37 citing papers in PubMed, 54 citations in OpenAlex.
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- Robot-Assisted Resection of Mediastinal Tumors in Pediatric Patients: A Systematic Review.Children (Basel, Switzerland) · 2026Review
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- 25 years of surgery in patients with congenital lung malformations: the Rotterdam experience.Pediatric surgery international · 2026Article
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- [Surgical management of children with liver tumors in Germany : Evidence, care structures and future perspectives].Chirurgie (Heidelberg, Germany) · 2026Review
- Fecal diversion in anorectal malformations: is there a place for ileostomy? The ARM-Net Consortium experience including a narrative literature review.Pediatric surgery international · 2026Review
- Transumbilical Laparoscopic-Assisted (TULA) Surgery for Treating Abdominal Pathologies in Newborns: A Retrospective Single-Center Experience.Children (Basel, Switzerland) · 2026Article
- Surgical outcomes in neonates and infants with congenital choledochal malformation: analysis of the Pediatric Health Information System (PHIS) database.Pediatric surgery international · 2026Article
- Low Detection Rate of Possible Anesthesia-Related Complications After Pediatric Inguinal Hernia Repair Challenges Current Postoperative Monitoring Protocols.Journal of clinical medicine · 2026Article
- Non-operative treatment strategy versus surgery for children with simple appendicitis: non-inferiority randomised controlled trial.BMJ medicine · 2026Article
- Congenital stomised omphalocele: a case report and scoping literature review.Frontiers in pediatrics · 2026Review
- Short-term outcomes of centralization on surgical care for patients with anorectal malformations: retrospective cohort study.BJS open · 2025Article
- Biliary Reconstruction in Liver Transplantation with Primary Sclerosing Cholangitis: Roux-en-Y Hepaticojejunostomy or Duct-to-Duct Anastomosis?Journal of clinical medicine · 2025Article
- Intussusception around jejunal feeding tubes in pediatric patients: a retrospective two-center experience and management strategies.Pediatric surgery international · 2025Article
- Postoperative complications following surgery for congenital hyperinsulinism and insulinomas in pediatric patients.Pediatric surgery international · 2025Article
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Authors and funding
9 authors at 4 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInconsistent definitions of complications and unexpected events have limited accurate analysis of surgical outcomes. Perioperative outcome classifications currently used for adult patients have limitations when used for children.
methodsA multidisciplinary group of experts modified the Clavien-Dindo classification to increase its utility and accuracy in paediatric surgery cohorts. Organizational and management errors were considered in the novel Clavien-Madadi classification, which focuses on procedural invasiveness rather than anaesthetic management. Unexpected events were prospectively documented in a paediatric surgery cohort. Results of the Clavien-Dindo and Clavien-Madadi classifications were compared and correlated with procedure complexity.
resultsUnexpected events were prospectively documented in a cohort of 17 502 children undergoing surgery between 2017 and 2021. The results of both classifications were highly correlated (ρ = 0.95), although the novel Clavien-Madadi classification identified 449 additional events (organizational and management errors) over the Clavien-Dindo classification, increasing the total number of events by 38 per cent (1605 versus 1158 events). The results of the novel system correlated significantly with the complexity of procedures in children (ρ = 0.756). Furthermore, grading of events > grade III according to the Clavien-Madadi classification showed a higher correlation with procedure complexity (ρ = 0.658) than the Clavien-Dindo classification (ρ = 0.198).
conclusionThe Clavien-Madadi classification is a tool for the detection of surgical and non-medical errors in paediatric surgery populations. Further validation in paediatric surgery populations is required before widespread use.
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