Modified Clavien-Dindo Classification with scoring: A retrospective cohort study benchmarking morbidity in autologous breast reconstruction.

Abstract

Although total flap loss in autologous breast reconstruction is rare, minor complications remain prevalent. The authors recently published a modified Clavien-Dindo Classification to more accurately categorise these complications. We propose a further scoring modification to better quantify morbidity in this cohort. A numerical complication scoring extension to the Modified Clavien-Dindo Classification was developed, assigning weighted, non-linear numerical values to each grade to reflect the relative morbidity associated with the complication and intervention required for its management. This scoring system was applied retrospectively to a consecutive cohort of patients undergoing microsurgical breast reconstruction at a single tertiary centre. Complication scores were analysed across reconstruction types and patient risk factors, including age and body mass index (BMI). In total, 247 patients were included. The mean complication score across the entire cohort was 0.49, indicating a low overall morbidity burden. Although overall complication rates were comparable between the reconstruction types, mean complication scores were significantly higher in thigh-based flaps compared to abdominal-based flaps, demonstrating differences in morbidity that were not captured by complication rates alone. Increasing age and BMI were associated with significantly higher mean complication scores, reflecting increased frequency and severity of postoperative complications in these subgroups. This numerical extension to the modified Clavien-Dindo Classification provides a simple and intuitive method for quantifying postoperative morbidity following autologous breast reconstruction. By capturing complication burden rather than severity alone, the scoring system supports more nuanced risk stratification, outcome benchmarking and informed, shared decision-making.