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Application of the comprehensive complication index and Clavien-Dindo complication classification in cardiac surgery:
Zhen-Rong Zhang1, Yang-Zheng Li2, Xiao-Qing Wu1
1Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, Zhejiang, 310000, China.
Insights
The Comprehensive Complications Index (CCI) and Clavien Dindo Complications Classification (CDCC) accurately assess cardiac surgery complications. These tools can reduce clinical trial sample sizes, improving research efficiency.
Area of Science:
- Cardiology
- Surgical Outcomes
- Medical Informatics
Background:
- Accurate assessment of postoperative complications in cardiac surgery is crucial for patient management and outcome evaluation.
- Standardized tools are needed to quantify complication severity.
- This study evaluates the Clavien Dindo Complications Classification (CDCC) and Comprehensive Complications Index (CCI) in cardiac surgery.
Purpose of the Study:
- To evaluate the application and utility of the CDCC and CCI in cardiac surgery.
- To determine if these indices accurately reflect surgical complexity and patient outcomes.
- To assess the potential of CCI to reduce sample size requirements in clinical trials.
Main Methods:
- Retrospective analysis of 563 cardiac surgery patients.
- Application of CDCC and CCI to classify and quantify postoperative complications.
- Statistical analysis to correlate complication scores with surgical complexity, hospitalization costs, length of stay, and sample size reduction.
Main Results:
- 76.3% of patients experienced at least one complication, with a mean CCI of 22.5 ± 19.3.
- Higher CDCC grades and CCI scores correlated with more complex surgeries, increased hospitalization costs, and longer hospital stays.
- CCI demonstrated a potential to reduce required sample sizes by over 20 times compared to traditional endpoints.
Conclusions:
- The CCI and CDCC effectively reflect cardiac surgery complexity and hospitalization burden.
- These indices provide a more accurate assessment of surgical complications.
- Utilizing CCI and CDCC can facilitate cardiac surgery research by reducing necessary sample sizes for clinical trials.
Background:
Standardized tools are needed to accurately assess the severity of postoperative complications in cardiac surgery, which is critical for patient management and outcome evaluation. This study aims to evaluate the application of the Clavien Dindo Complications Classification (CDCC) and Comprehensive Complications Index (CCI) in cardiac surgery.
Results:
563 patients (76.3%) had at least one complication. The mean CCI was 22.5 ± 19.3. Patients who underwent more complex surgeries had higher CDCC grades and CCI scores. Hospitalization cost and length of stay increased with increasing CDCC grade and CCI score. The ACCI (OR: 1.334 [1.109-1.606], p = 0.002) and LVEF (OR: 0.965 [0.943-0.987], p = 0.002) were associated factors for the most severe complications. The CCI may reduce the required sample size by 20.5 times and 19.6 times compared with the most severe complication or major adverse cardiovascular and cerebrovascular events, respectively, as an endpoint.
Conclusion:
The CCI and CDCC can help reflect the complexity of cardiac surgery and the burden of hospitalization, providing a more accurate assessment of surgical complications. This may reduce the sample size needed for clinical trials, thus facilitating research in cardiac surgery.
Clinical Trial Registration:
Chinese Clinical Trial Registry (No. ChiCTR2400084925) on May 28th, 2024. https://www.chictr.org.cn/showproj.html?proj=228499 .
