Validation of the Clavien–Dindo Grading System in Urology by the European Association of Urology Guidelines Ad Hoc Panel

Abstract Context Since 2012 uniformed reporting of complications after urological procedures has been advocated by the European Association of Urology (EAU) guidelines. The Clavien–Dindo grading system was recommended to report the outcomes of urologic procedures. Objective To validate the Clavien–Dindo grading system in urology. Design, setting, and participants Members of the EAU working group compiled a list of case scenarios including those with minor and major complications. A survey was administered online via Survey Monkey to the members of EAU committees for the appropriate grading according to the Clavien–Dindo classification of surgical complications. Scenarios with intraoperative complications were intentionally included to assess respondents’ awareness of the Clavien–Dindo applicability. Outcome measurements and statistical analysis Survey data collected were used to calculate agreement rates and to estimate the overall inter-rater agreement on all cases using Fleiss’ kappa ( κ ). Differences in agreement rates for each scenario among groups with different criteria about the system were estimated using the chi-square test. Results and limitations Evaluable responses were received from 81 out of 174 invited raters (46.5%). Of them 56.9% believed that the Clavien–Dindo system was adequate for grading postoperative complications. The agreement rate was over a score of ≥80% in nine cases, 60–79% in 10 cases, 40–59% in 14 cases, and