Background: The aim of this study was to evaluate whether Accordion Severity Grading System can serve as a tool for classification, and severity assessment in reporting postoperative complications after breast reconstructive surgery. Methods: A retrospective analysis covered 88 breast reconstruction surgeries following mastectomy and prophylactic breast amputation with simultaneous reconstruction conducted from January 2015 to December 2017. All registered postoperative complications were evaluated using the Accordion Severity Grading System. The time horizon selected was 6 weeks after surgery. Results: Eighty-two adverse events which met the criteria for complications according to the Accordion classification were observed in 53.4% (n = 47) of the patients. The highest percentage of complications was observed in the group where reconstruction involved using autologous tissues (pedicled transverse rectus abdominis myocutaneous), which were associated with 77.4% risk of complications. In patients with combined methods (latissimus dorsi + prosthesis), complications occurred in half of the cases (51.4%). In patients who underwent reconstructive procedures with artificial materials (expander/prosthesis), complications occurred in 20% of cases. A high γ correlation coefficient of 0.7 (P < .001) was observed between the Accordion degree assigned to the patient and the length of hospital stay. A moderately strong correlation was found between the degree of Accordion system and rehospitalization rate (r = 0.54; P < .0001) and cost of hospital care (r = 0.65; P < .001). Discussion: Based upon the presented study, Accordion Severity Grading System is a workable, intuitive and universal scale for classifying and assessing the severity of postoperative complications and may be recommended for documenting complications in breast reconstructive procedures.
ClavienPASanabriaJRStrasbergSM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518–526.
2.
DindoDDemartinesNClavienPA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. doi:10.1097/01.sla.0000133083.54934.ae
3.
StrasbergSMLinehanDCHawkinsWG. The Accordion Severity Grading System of surgical complications. Ann Surg. 2009;250(2):177–186. doi:10.1097/SLA.0b013e3181afde41
4.
Accordion Severity Grading of Postoperative Complications. Standard Complication Reporting Tables. Department of Surgery, Washington University in St Louis. Published August 01, 2009. Accessed August 10, 2020. https://www.accordionclassification.wustl.edu/PostopIntro1.aspx
5.
PorembkaMRHallBLHirbeMStrasbergSM. Quantitative weighting of postoperative complications based on the Accordion Severity Grading System: demonstration of potential impact using the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210(3):286–298. doi:10.1016/j.jamcollsurg.2009.12.004
6.
American College of Surgeons. User Guide for the 2016 ACS NSQIP Procedure targeted participant use data file (PUF). American College of Surgeons National Surgical Quality Improvement Program. Published October 2017. Accessed August 10, 2017. https://www.facs.org/quality-programs/acs-nsqip/participant-use
JungMRParkYKSeonJWKimKYCheongORyuSY. Definition and classification of complications of gastrectomy for gastric cancer based on the Accordion Severity Grading System. World J Surg. 2012;36(10):2400–2411. doi:10.1007/s00268-012-1693-y
9.
XuLYangBLiGPGaoD. Assessment of complications after liver surgery: Two novel grading systems applied to patients undergoing hepatectomy. J Huazhong Univ Sci Technolog Med Sci. 2017;37(3):352–356. doi:10.1007/s11596-017-1739-3
10.
CarrottPWMarkarSRKuppusamyMKTraversoLWLowDE. Accordion Severity Grading System: assessment of relationship between costs, length of hospital stay, and survival in patients with complications after esophagectomy for cancer. J Am Coll Surg. 2012;215(3):331–336. doi:10.1016/j.jamcollsurg.2012.04.030
11.
MitropoulosDArtibaniWGraefenMRemziMRouprêtMTrussM.Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol. 2012;61(2):341–349. doi:10.1016/j.eururo.2011.10.033
12.
BoganiGCromiAUccellaS, et al.Laparoscopic versus open abdominal management of cervical cancer: long-term results from a propensity-matched analysis. J Minim Invasive Gynecol. 2014;21(5):857–862. doi:10.1016/j.jmig.2014.03.018
13.
AbbottSUngerCAEvansJM, et al.Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study. Am J Obstet Gynecol. 2014;210(2):163. e1-e163. e8. doi:10.1016/j.ajog.2013.10.012
14.
KumarABakkum-GamezJNWeaverALMcGreeMEClibyWA. Impact of obesity on surgical and oncologic outcomes in ovarian cancer. Gynecol Oncol. 2014;135(1):19–24. doi:10.1016/j.ygyno.2014.07.103
15.
KumarAJancoJMMarianiA, et al.Risk-prediction model of severe postoperative complications after primary debulking surgery for advanced ovarian cancer. Gynecol Oncol. 2016;140(1):15–21. doi:10.1016/j.ygyno.2015.10.025
16.
AlbrightBBWitteTTofteAN, et al.Robotic versus laparoscopic hysterectomy for benign disease: a systematic review and meta-analysis of randomized trials. J Minim Invasive Gynecol. 2016;23(1):18–27. doi:10.1016/j.jmig.2015.08.003
17.
BoganiGCromiAUccellaS, et al.Laparoscopic versus vaginal hysterectomy for benign indications in women aged 65 years or older: propensity-matched analysis. Menopause. 2015;22(1):32–35. doi:10.1097/GME.0000000000000263
18.
NoszczykBHNowakMKrześniakN. Use of the Accordion Severity Grading System for negative outcomes of carpal tunnel syndrome. J Plast Reconstr Aesthet Surg. 2013;66(8):1123–1130. doi:10.1016/j.bjps.2013.04.016
19.
NoszczykBKrześniakN. The Accordion system classification of negative outcomes in aesthetic surgery. Plast Reconstr Surg. 2014;134(suppl 1):120–121.
20.
NoszczykB. Powikłania i zdarzenia niepomyślne w chirurgii estetycznej. Chir po Dyplomie/Postgraduate Surg. 2014;9(5):28–31.
21.
NickelKFoxIMargenthalerJWallaceAFraserVOlsenM. The effect of non-infectious wound complications after mastectomy on subsequent surgical procedures and early implant loss. J Am Coll Surg. 2016;222(5):844–852. doi:10.1016/j.jamcollsurg.2016.01.050
22.
KlosCLSafarBHuntSR, et al.Accordion complication grading predicts short-term outcome after right colectomy. J Surg Res. 2014;190(2):510–516. doi:10.1016/j.jss.2013.11.1084
23.
StrasbergSMHallBL. Postoperative Morbidity Index: a quantitative measure of severity of postoperative complications. J Am Coll Surg. 2011;213(5):616–626. doi:10.1016/j.jamcollsurg.2011.07.019
