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The Comprehensive Complication Index in Postoperative Assessment After Head and Neck Reconstruction

Takeaki Hidaka1, Shimpei Miyamoto2, Yutaka Fukunaga3

  • 1Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Journal of Surgical Oncology
|September 8, 2025
PubMed

Insights

The Comprehensive Complication Index (CCI) offers a better assessment of complication burden in head and neck free-flap reconstruction than the Clavien-Dindo Classification (CDC). CCI identified more risk factors for complications.

Area of Science:

  • Head and Neck Surgery
  • Reconstructive Surgery
  • Surgical Outcomes

Background:

  • Postoperative complications are a major concern in head and neck free-flap reconstruction.
  • The Comprehensive Complication Index (CCI) is a continuous measure of complication burden.
  • The Clavien-Dindo Classification (CDC) is more commonly used than CCI in head and neck surgery.

Purpose of the Study:

  • To compare the Comprehensive Complication Index (CCI) and Clavien-Dindo Classification (CDC) in evaluating complication burden after head and neck free-flap reconstruction.
  • To identify risk factors associated with increased complication burden using the CCI.

Main Methods:

  • Retrospective analysis of 354 patients undergoing head and neck free-flap reconstruction.
  • Complications were graded using the Clavien-Dindo Classification (CDC).
  • The Comprehensive Complication Index (CCI) was calculated, and multivariable linear regression identified risk factors for increased CCI.

Main Results:

  • A total of 413 complications were recorded in 252 patients.
  • CCI analysis identified mandibular reconstruction, diabetes mellitus, and prolonged operative time as significant risk factors for increased complication burden.
  • CDC analysis identified only prolonged operative time as a significant risk factor.

Conclusions:

  • The Comprehensive Complication Index (CCI) provides a more thorough assessment of postoperative morbidity in head and neck free-flap reconstruction.
  • CCI has the potential to improve the evaluation of complication burden in this surgical population.
Abstract

Keywords:
Clavien‐Dindo classificationcomprehensive complication indexfree‐flap reconstructionhead and neck surgery

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