Objectives  To establish a grading system of surgical complications for musculoskeletal tumors and to assess the accuracy of its preliminary application.

  Methods   A total of 6, 120 patients with musculoskeletal tumors admitted for surgical therapy in Department of Musculoskeletal Oncology, Fudan University Cancer Center between August 2011 and December 2016 were retrospectively reviewed. The surgical complications were graded according to the Clavien- Dindo system.

  Results   Data were obtained objectively in charts. Of the 6, 120 patients who underwent surgery, the overall complication rate was only 8.4%, although complicated reconstruction was performed in 1, 136/6, 120 (18.6%) cases. Grade 3 or more severe surgical complications were observed in only 38/6, 120 (0.62%) patients, all of whom underwent complicated reconstruction. Cardiopulmonary cerebral-associated death occurred in 5 cases.

  Conclusions  The 5-grade system of surgical complications might be an applicable tool in evaluating surgical quality in the treatment of musculoskeletal tumors. Complications were more prone to occur in complicated surgeries. Further studies are needed to investigate the risk factors and to decrease the occurrence rate in patients with high risks.