“The modified CIRSE classification system is not just a technical update; it’s expected to have meaningful clinical, educational, and quality-assurance impacts on daily practice and complication reporting. This new version enhances reproducibility and at the same time preserves simplicity while improving accuracy.”
These are the thoughts of Dimitrios Filippiadis (National and Kapodistrian University of Athens, Athens, Greece), co-author of a new standard of practice paper outlining a modified classification of complications produced by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Originally published in 2017, the update addresses shortcomings found in the original system regarding patient outcomes, presence of complications, impact on hospitalisation, severity of the complication and sequalae in a patient’s everyday life.
The original system described six grades: grade 1: complication could be solved within the same procedure, grade 2: unplanned prolonged hospitalisation of less than 48 hours without an additional therapy, grade 3: additional therapies needed or hospitalisation of more than 48 hours, but no sequelae, grade 4: mild sequelae beyond hospitalisation, grade 5: severe sequelae requiring assistance in daily life, and grade 6: death.
Following an initial evaluation of the classification system during the 2023 International Conference on Complications in Interventional Radiology (ICCIR; 1–3 June, Pörtschach am Wörthersee, Austria), the committee sought to modify grades 1 and 3. Grade 1 refers to the degree of impact on the patient in terms of success or failure of the procedure and grade 3 to the duration of hospital stay.
The modifications made to grade 1 and 3 are as follows:
- Grade 1 was subdivided into 1a and 1b. 1a refers to situations where the complication was solved within the same procedure and 1b to scenarios when the complication was resolved within the same procedure, but the intended procedure was not completed.
- Grade 3 was subdivided to create 3a and 3b. 3a which identifies a hospital stay of more than 48 hours but less than two weeks, and 3b which refers to a stay longer than two weeks. Grade 3 subgroups have been created to depict the complications that resulted in the most time and resource consuming hospitalisations.
“The classification approach utilised in the modified CIRSE classification system emphasises the combination of outcome, presence of complication, impact on hospitalisation and severity of a specific complication and sequelae in a patient’s everyday life,” says Filippiadis.
He continues: “The refinements in the modified CIRSE system for classification of complications reduce grey areas providing clearer definitions and examples. This contributes to standardising complications reports which is vital for multicentred registries enabling more robust meta-analyses and outcome research, audits and benchmarking. The new subdivisions correlate more closely with utilisation of resources helping physicians and administrators to assess true procedural burden and cost implications of complications.”
