Accordion Calculator

This web page will calculate the severity grades of postoperative complications based on the accordion severity grading system.

Q1. Minor procedures done at the bedside - including insertion of intravenous lines, urinary catheters, nasogastric tubes, or drainage of wound infection?

Q2. Was treatment required with drugs - including anti-emetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy?

Q3. Were antibiotics, or drugs other than types listed in Q2 required? Or were blood transfusions or total parenteral nutrition required?

Q4. Were there any treatments such as endoscopic, interventional, or reoperation required that DID NOT require general anesthesia

Q5. Was general anesthesia required to treat a complication?

Q6. Did a single-organ system fail?

Q7. Did two or more organ systems fail?

Q8. Did a postoperative death occur within 100 days of surgery?


Grade Revised Accordion classification
Mild 1 Requires only minor invasive procedures that can be done at the bedside, such as insertion of intraveneous lines, urinary catheters, and nasogastric tubes, and drainage of wound infections. Physiotherapy and anti-emetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy are permitted (case 1,2).
Moderate 2 Requires pharmacologic treatment with drugs other than such allowed for minor complications, eg. antibiotics. Blood transfusions and total parenteral nutrition are also included (cases 3,4).
Severe 3 No general anesthesia: requires management by an endoscopic, interventional procedure or reoperation without general anesthesia (cases 5,6).
4 General anesthesia or single organ failure (cases 7,8,9).
5 General anesthesia or single organ failure or multisystem organ failure (>2 organ systems)(case 10).
Death 6 Postoperative death (case 11, 12).

Definitions of Organ Failure for Accordion Classification of Postoperative Complications

• Cardiac: Need for any of the following medications:
   • Norepinephrine > 0.1 µg/kg-1 · min-1
   • Epinephrine > 0.1 µg/kg-1 · min-1
   • Dopamine > 15 µg/kg-1 · min-1
• Central nervous system: Glasgow coma scale • Hematologic: Platelet count < 20 x 109/L
• Liver: Need for FFP to correct INR in patient with serum bilirubin >12 mg/dL (205 mMoles/L) OR INR > 2.5 in patient with serum bilirubin >12 mg/dL (205 mMoles/L)
• Renal: Need for dialysis
• Respiratory: Need for mechanical ventilation for > 24 h in a patient who requires reintubation after surgery OR need for mechanical ventilation of > 72 h in a patient who is not extubated on the day of surgery

"Modified" Accordion Classification reference:
J AM Coll Surg 210;286-98, 2010. The Accordion Severity Grading System of Surgical Complications