Table 3 Common head and neck/general complications conformed to the Clavien-Dindo classification

Neck wound infection

Localised and superficial to platysma, e.g. stitch abscess

I

Spreading cellulitis or superficial wound infection with no underlying collection treated with antibiotics

II

Collection deep to platysma requiring drainage (not under GA)

IIIa

Collection deep to platysma requiring drainage (under GA)

IIIb

Large collection with organ and/or life-threatening sequelae (i.e. airway obstruction, severe sepsis, septic shock)

IV (a or b depending on organ dysfunction)

Other surgical site infection

Localised infection requiring topical or non-invasive treatment

I

Infection requiring treatment with antibiotics only

II

Collection requiring drainage (not under GA)

IIIa

Collection requiring drainage (under GA)

IIIb

Large collection with organ and/or life-threatening sequelae (i.e. airway obstruction, severe sepsis, septic shock)

IV (a or b depending on organ dysfunction

Bleeding/haematoma

Haematoma not requiring drainage or suitable for simple aspiration with a needle (not radiologically guided)

I

Need for blood transfusion

II

Requiring drainage (not under GA). Includes radiologically guided aspiration/drainage

IIIa

Requiring drainage or return to theatre for haemostasis (under GA)

IIIb

Haematoma/haemorrhage sufficiently large to obstruct airway or cause hypovolaemic shock

IV (a or b depending on organ dysfunction)

Chyle leak

Low output leak (< 500 ml/24 h) suitable for low-fat diet and compression only

I

Requirement for pharmacological management including total parenteral nutrition

II

Radiologically guided occlusion

IIIa

Return to theatre for the procedure under GA

IIIb

Evidence of end-organ dysfunction

IV (a or b depending on organ dysfunction)

Wound breakdown

Superficial skin dehiscence (platysma layer intact) managed with dressings

I

Small fistula managed by an enteral tube or parenteral nutrition only

II

Deep dehiscence (through platysma layer) or fistula managed with procedure not under GA

IIIa

Deep dehiscence (through platysma layer) or fistula managed with the procedure under GA

IIIb

Evidence of end-organ dysfunction

IV (a or b depending on organ dysfunction)

Seroma/sialocele

Small collection not requiring drainage or suitable for aspiration with a needle (not radiologically guided)

I

Salivary fistula managed medically (e.g. anticholinergic)

II

Requiring drainage (not under GA). Includes radiologically guided aspiration/drainage

IIIa

Requiring re-exploration and/or drainage (under GA)

IIIb

Large collection obstructing airway

IVa

Hypersensitivity

Mild reaction not requiring treatment

I

Mild/moderate/severe reaction treated with medication (e.g. antihistamine and/or steroid and/or adrenaline)

II

Anaphylactic shock

IV (a or b depending on organ dysfunction)

Air embolism

By definition clinically evident air embolism results in cardiorespiratory dysfunction

IVb

Pneumothorax/haemothorax

Small pneumothorax managed without a chest drain

I

Pneumothorax/Haemothorax without respiratory failure requiring chest drain

IIIa

Evidence of respiratory failure or any other organ dysfunction

IV (a or b depending on organ dysfunction)

Pulmonary embolism

Small PE without evidence of respiratory failure managed with anticoagulation only

II

Evidence of respiratory failure or any other organ dysfunction

IV (a or b depending on organ dysfunction)

Deep vein thrombosis

Managed with anticoagulation only

II

Need for endovascular intervention including filters not under GA

IIIa

Need for endovascular intervention or surgical thrombectomy under GA

IIIb

Lower respiratory tract infection (including aspiration)

Managed with physiotherapy only

I

Managed with antibiotics

II

Evidence of respiratory failure or any other organ dysfunction

IV (a or b depending on organ dysfunction)