The Accordion System Classification of Negative Outcomes in Aesthetic Surgery

Purpose

The modified version of the Clavien-Dindo classification of complications has been renamed the Accordion Severity Grading System (1). Since its introduction it has received international acceptance in various surgical specialties. However, it has never been used in aesthetic surgery.

The Accordion System enables a simple assessment and comparison of the outcomes between various procedures and centres. We propose using it in aesthetic surgery to provide a common language for research and discussion where real complications can be distinguished from failures, or as after-effects of interventions.

Methods

The Accordion System categorizes negative outcomes into complications, sequelae, and failures to cure. Complications, which can subsequently be graded by required treatment, are defined as unintended events: (i) which are unrelated to the purpose of the procedure and occur in its temporal proximity, (ii) induce a change in management, and (iii) are morbid. Sequelae of procedures are defined as after-effects where risk is inherent, and sequelae of complications as complications resulting in lasting disability. Failures to cure are failures to attain or maintain the purpose of the procedure.

We have retrospectively revised the charts of more than 700 aesthetic procedures performed in the university department of plastic surgery in an endeavour to categorize negative events into complications, sequelae and failures. Complications were not graded in this pilot study. Follow up visits were carried out more than a year.

Results

When categorized using Accordion definitions, many negative events in aesthetic surgery should be reported as sequelae or failures. For example, among 300 rhinoplasty patients, 199 (66.3%) adverse events were observed. The majority (58.3%) of complaints related to early airflow deterioration, while 4.7% to late deformities. These were considered to be sequelae of procedure, and failures. Among the same number of breast augmentation patients, 2,7 % events related to capsular contracture grades II - III, and were considered sequelae of complication.

Conclusions

Because of the stipulated time horizon for reporting complications, which in the Accordion System is a proposed maximum of six weeks, the negative events observed and treated at a later stage could not be categorized as complications. Nevertheless, many should logically be interpreted as sequelae or failures.