Skip to main content
SpringerLink
Log in

Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System

  • CIRSE Standards of Practice Guidelines
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Interventional radiology provides a wide variety of vascular, nonvascular, musculoskeletal, and oncologic minimally invasive techniques aimed at therapy or palliation of a broad spectrum of pathologic conditions. Outcome data for these techniques are globally evaluated by hospitals, insurance companies, and government agencies targeting in a high-quality health care policy, including reimbursement strategies. To analyze effectively the outcome of a technique, accurate reporting of complications is necessary. Throughout the literature, numerous classification systems for complications grading and classification have been reported. Until now, there has been no method for uniform reporting of complications both in terms of definition and grading. The purpose of this CIRSE guideline is to provide a classification system of complications based on combining outcome and severity of sequelae. The ultimate challenge will be the adoption of this system by practitioners in different countries and health economies within the European Union and beyond.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dindo D, Clavien PA. What is a surgical complication? World J Surg. 2008;32:939–41.

    Article  PubMed  Google Scholar 

  2. Roos LL, Stranc L, James RC, Li J. Complications, co-morbidities, and mortality: improving classification and prediction. HSR Health Serv Res. 1997;32(2):229–38.

    CAS  PubMed  Google Scholar 

  3. Leoni CJ, Potter JE, Rosen MP, Brophy DP, Lang EV. Classifying complications of interventional procedures: a survey of practicing radiologists. J Vasc Interv Radiol. 2001;12(1):55–9.

    Article  CAS  PubMed  Google Scholar 

  4. Dindo D, Demartines N, Clavien PA. 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):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pomposelli JJ, Gupta SK, Zacharoulis DC, Landa R, Miller A, Nanda R. Surgical complication outcome (SCOUT) score: a new method to evaluate quality of care in vascular surgery. J Vasc Surg. 1997;25(6):1007–14 (discussion 1014–1015).

    Article  CAS  PubMed  Google Scholar 

  6. Common Terminology Criteria for Adverse Events (CTCAE) v4.0 National Cancer Institute; http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.

  7. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  8. Clavien PA, Strasberg SM. Severity grading of surgical complications. Ann Surg. 2009;250(2):197–8.

    Article  PubMed  Google Scholar 

  9. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009;250(2):177–86. doi:10.1097/SLA.0b013e3181afde41.

    Article  PubMed  Google Scholar 

  10. Porembka MR, Hall BL, Hirbe M, Strasberg SM. 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):286–98.

    Article  PubMed  Google Scholar 

  11. Graefen M. The modified Clavien system: a plea for a standardized reporting system for surgical complications. Eur Urol. 2010;57(3):387–9.

    Article  PubMed  Google Scholar 

  12. Bertges DJ, Shackford SR, Cloud AK, Stiles J, Stanley AC, Steinthorsson G, Ricci MA, Ratliff J, Zubis RR. Toward optimal recording of surgical complications: concurrent tracking compared to the discharge data set. Surgery. 2007;141(1):19–31.

    Article  PubMed  Google Scholar 

  13. Mitropoulos D, Artibani W, Biyani CS, Jensen JB, Remzi M, Rouprêt M, Truss M. Quality assessment of partial nephrectomy complications reporting using EAU standardised quality criteria. Eur Urol. 2014;66(3):522–6.

    Article  PubMed  Google Scholar 

  14. Tepeler A, Resorlu B, Sahin T, Sarikaya S, Bayindir M, Oguz U, Armagan A, Unsal A. Categorization of intraoperative ureteroscopy complications using modified Satava classification system. World J Urol. 2014;32(1):131–6.

    Article  PubMed  Google Scholar 

  15. Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258:1–7.

    Article  PubMed  Google Scholar 

  16. Strasberg SM, Hall BL. Postoperative morbidity index: a quantitative measure of severity of postoperative complications. J Am Coll Surg. 2011;213(5):616–26.

    Article  PubMed  Google Scholar 

  17. Rosenthal R, Hoffmann H, Clavien PA, et al. Definition and classification of intraoperative complications (CLASSIC): Delphi study and pilot evaluation. World J Surg. 2015;39(7):1663–71.

    Article  PubMed  Google Scholar 

  18. Kaafarani HMA, Mavros MN, Hwabejire J, et al. Derivation and validation of a novel severity classification for intraoperative adverse events. J Am Coll Surg. 2014;218(6):1120–8.

    Article  PubMed  Google Scholar 

  19. Ouriel K, Fowl RJ, Davies MG, Forbes TL, Gambhir RP, Ricci MA, Society for Vascular Surgery. Disease-specific guidelines for reporting adverse events for peripheral vascular medical devices. J Vasc Surg. 2014;60(1):212–25.

    Article  PubMed  Google Scholar 

  20. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA, Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.

    Article  CAS  PubMed  Google Scholar 

  21. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.

    CAS  PubMed  Google Scholar 

  22. Baker JD, Rutherford RB, Bernstein EF, Courbier R, Ernst CB, Kempczinski RF, Riles TS, Zarins CK. Suggested standards for reports dealing with cerebrovascular disease. Subcommittee on Reporting Standards for Cerebrovascular Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1988;8(6):721–9.

  23. Hisasue S, Takahashi A, Kato R, Shimizu T, Masumori N, Itoh N, Tsukamoto T. Early and late complications of radical retropubic prostatectomy: experience in a single institution. Jpn J Clin Oncol. 2004;34(5):274–9.

    Article  PubMed  Google Scholar 

  24. Strong VE, Selby LV, Sovel M, Disa JJ, Hoskins W, Dematteo R, Scardino P, Jaques DP. Development and assessment of Memorial Sloan Kettering Cancer Center’s Surgical Secondary Events grading system. Ann Surg Oncol. 2015;22(4):1061–7.

    Article  PubMed  Google Scholar 

  25. Ettorchi-Tardy A, Levif M, Michel P. Benchmarking: a method for continuous quality improvement in health. Healthc Policy. 2012;7(4):e101–19.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd Radiology Department, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari, Athens, Greece

    D. K. Filippiadis

  2. Institut für Radiologie und Nuklearmedizin, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, 8401, Winterthur, Switzerland

    C. Binkert

  3. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France

    O. Pellerin

  4. Assitance Publique Hopitaux de Paris, Hôpital Européen Georges Pompidou, Service de Radiologie Interventionnelle, Paris, France

    O. Pellerin

  5. Inserm 970, Paris, France

    O. Pellerin

  6. Insitute and Policlinic for Radiological Diagnostic, University Hospital Dresden, TU Dresden, Dresden, Germany

    R. T. Hoffmann

  7. Department of Radiology, University Hospital Faculty of Medicine, Charles University in Hradec Kralove, 50005, Hradec Králové, Czech Republic

    A. Krajina

  8. Clinic of Radiology, Minimally Invasive Therapies and Nuclearmedicine, SLK-Kliniken GmbH, Academic Hospital, Ruprecht-Karls-University Heidelberg, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany

    P. L. Pereira

Authors
  1. D. K. Filippiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Binkert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Pellerin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. T. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Krajina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. L. Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. K. Filippiadis.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Does not apply.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Filippiadis, D.K., Binkert, C., Pellerin, O. et al. Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System. Cardiovasc Intervent Radiol 40, 1141–1146 (2017). https://doi.org/10.1007/s00270-017-1703-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1703-4

Keywords

Search

Navigation