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The Assessment of Complications After Major Abdominal Surgery: A Comparison of Two Scales

Jelena Veličković1, Chen Feng2, Ivan Palibrk1

  • 1Intensive Care Unit, Clinical Center of Serbia, Clinic for Digestive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.

The Journal of Surgical Research
|November 3, 2019
PubMed

Insights

The Comprehensive Complication Index (CCI) better captures postoperative morbidity in high-risk surgical patients than the Clavien-Dindo classification (CDC). CCI correlates more strongly with hospital length of stay, offering a more accurate assessment of surgical outcomes.

Area of Science:

  • Surgical outcomes research
  • Patient safety and quality improvement
  • Clinical epidemiology

Background:

  • Accurate assessment of postoperative morbidity is crucial for evaluating surgical outcomes.
  • Current methods for reporting surgical complications lack consensus, with the Clavien-Dindo classification (CDC) focusing only on the most severe complication.
  • The Comprehensive Complication Index (CCI) has been developed to quantify the overall burden of complications.

Purpose of the Study:

  • To validate and compare the efficacy of the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI).
  • To assess these complication scoring systems in high-risk surgical patients where multiple complications are common.
  • To determine the correlation of CDC and CCI with hospitalization indicators and functional recovery post-surgery.

Main Methods:

  • A prospective, observational study involving 206 high-risk adult patients undergoing major abdominal surgery.
  • Postoperative complications were meticulously recorded until discharge or 30-day readmission.
  • Complication severity was graded using the CDC, and the CCI was subsequently calculated for comparative analysis.

Main Results:

  • A total of 424 complications were documented in 125 (60.7%) patients, with a median CCI of 20.9.
  • Both CCI and CDC showed a strong correlation (r=0.969, P<0.01), but CCI demonstrated stronger associations with intensive care unit length of stay (LOS) and overall postoperative LOS.
  • The CCI and highest CDC grade significantly differed concerning functional activity upon discharge (P<0.001).

Conclusions:

  • Both the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI) are effective for reporting complications after major abdominal surgery.
  • The CCI provides a more accurate and comprehensive measure of morbidity in high-risk surgical patients.
  • The CCI shows a superior correlation with postoperative length of stay, enhancing its utility in outcome assessment.
Abstract

Keywords:
Clavien-Dindo classificationHigh-risk patientMajor abdominal surgeryPostoperative complicationsThe Comprehensive Complication Index

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