Assessment of Adapted Clavien-Dindo Classification (ACDiT) as aTool for Reporting and Grading Negative Outcomes in Acute CareSurgical Patients: A Prospective Study at a Tertiary Care Centre

Abstract

Background: Acute care surgery (ACS) encompasses emergency general surgery, trauma, surgical rescue, and critical care, all of which carry significant risk of complications. Mortality rates have declined with modern resuscitation and damage-control strategies, making non-fatal complications more meaningful outcome measures. The traditional Clavien-Dindo classification (CDC) has limitations in ACS, especially in non-operative management. The Adapted Clavien-Dindo in Trauma (ACDiT) scale addresses these gaps by incorporating trauma-specific modifications.

Aim: To assess the feasibility of using ACDiT for grading non-mortality complications across the spectrum of acute care surgical patients, and to evaluate its correlation with outcomes and critical care scoring systems.

Methods: A prospective observational study was conducted in the Department of Traumatology and Surgery at a tertiary care hospital. All ACS patients admitted during the study period, both trauma and non-trauma, were included. Complications were graded using the ACDiT system. Outcomes measured included hospital stay, ICU stay, and correlation with critical care scores. Statistical analyses were performed to determine associations between ACDiT grade and patient outcomes. Ethical clearance was obtained.

Results: A significant proportion of patients developed complications that could be systematically classified using ACDiT. Increasing ACDiT grades correlated with longer ICU stay, prolonged hospitalization, and adverse outcomes. The classification was applicable to both operative and non-operative cases, demonstrating feasibility in the heterogeneous ACS population. Higher complication grades were consistent with worse outcomes when compared with critical care scoring systems.

Conclusion: ACDiT is a feasible and reliable tool for grading complications in acute care surgery. It provides a standardized framework applicable to trauma and non-trauma cases, allows meaningful comparison of outcomes, and complements critical care scoring systems. Adoption of ACDiT can improve reporting quality, facilitate benchmarking across centres, and enhance quality improvement initiatives.