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Comparing the Comprehensive Complication Index and Clavien-Dindo classification for evaluating postoperative
Yeon Su Kim1, Seung Yoon Yang2, Na Reum Kim3
1Department of Hepatobiliary and Pancreatic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
The Comprehensive Complication Index better reflects postoperative morbidity than the Clavien-Dindo classification in major abdominal surgeries. This comprehensive index correlates more strongly with hospital stay and costs, offering a more complete assessment of patient outcomes.
Area of Science:
- Surgical Outcomes Research
- Patient Morbidity Assessment
- Health Economics in Surgery
Background:
- The Clavien-Dindo classification is standard for postoperative complications but may underreport overall morbidity.
- The Comprehensive Complication Index (CCI) aggregates all complications into a single score.
- Limited studies compare CCI and Clavien-Dindo across diverse major abdominal surgeries.
Purpose of the Study:
- To compare the Comprehensive Complication Index and Clavien-Dindo classification in major abdominal surgeries.
- To assess the correlation of both indices with length of hospital stay and cost.
- To determine which index provides a more comprehensive measure of postoperative morbidity.
Main Methods:
- Retrospective analysis of 824 patients undergoing elective major abdominal surgery.
- Calculation of Clavien-Dindo classification and CCI for all patients.
- Correlation analysis of both indices with length of hospital stay and cost.
Main Results:
- A strong correlation was found between CCI and Clavien-Dindo (r = 0.795, P < .001).
- CCI demonstrated a stronger correlation with length of hospital stay (r=0.770) and cost (r=0.784) compared to Clavien-Dindo (r=0.571 and r=0.645, respectively).
- Both correlations were statistically significant (P < .001).
Conclusions:
- The Comprehensive Complication Index is a more sensitive indicator of postoperative morbidity in major abdominal surgery.
- CCI shows superior correlation with length of hospital stay and costs compared to the Clavien-Dindo classification.
- CCI offers a more comprehensive and informative tool for evaluating surgical outcomes.
Background:
The Clavien-Dindo classification has been widely used to evaluate postoperative complications; however, it captures only the most severe event and may underestimate the overall morbidity burden. The Comprehensive Complication Index, developed to address this limitation, aggregates all complications into a single continuous score. Comprehensive evaluations of the Clavien-Dindo classification and Comprehensive Complication Index across diverse major abdominal surgical procedures are scarce, with most existing studies limited by relatively small cohorts and a focus on specific diseases.
Methods:
We retrospectively analyzed 824 patients who underwent elective major abdominal surgeries (total gastrectomy, colorectal surgery with liver resection, major hepatectomy, and pancreatoduodenectomy) at a single tertiary center between January 2020 and December 2022. The Clavien-Dindo classification and Comprehensive Complication Index were calculated for each patient using postoperative data, and their correlation with length of hospital stay and cost was assessed. The correlation power between the Comprehensive Complication Index and Clavien-Dindo classification was compared.
Results:
Pearson correlation analysis revealed a strong correlation between the Comprehensive Complication Index and Clavien-Dindo classification (r = 0.795, P < .001). When examined in relation to clinical outcomes using correlation coefficients, the Comprehensive Complication Index showed a stronger correlation with length of hospital stay and cost than the Clavien-Dindo classification did (Comprehensive Complication Index versus Clavien-Dindo classification: length of hospital stay (r) 0.770 vs 0.571, P < .001; cost (r) 0.784 vs 0.645, P < .001).
Conclusion:
The Comprehensive Complication Index shows a stronger correlation with length of hospital stay and costs than the Clavien-Dindo classification did in major abdominal surgeries, supporting its use as a more informative and comprehensive tool for assessing postoperative morbidity.
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