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Evaluation of the Comprehensive Complication Index Versus the Clavien-Dindo Classification for Predicting Clinical

Xinfang Zhang1,2, Lu Zhang1, Jimei Chen2

  • 1Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China.

Journal of Cardiovascular Development and Disease
|December 24, 2025
PubMed

Insights

The Comprehensive Complication Index (CCI) better evaluates outcomes after cardiac surgery than the Clavien-Dindo classification (CDC). CCI demonstrated stronger correlations with ICU stay, hospital stay, and costs, indicating its superior discriminative ability for adult cardiac surgery patients.

Area of Science:

  • Cardiac Surgery
  • Surgical Outcomes
  • Clinical Assessment Tools

Background:

  • Adult cardiac surgery patients face significant risks of postoperative complications.
  • Current methods for assessing outcomes after complications lack consensus.

Purpose of the Study:

  • To validate the Comprehensive Complication Index (CCI) and Clavien-Dindo classification (CDC) for evaluating clinical outcomes in adult cardiac surgery.
  • To compare the discriminative ability of CCI and CDC in relation to postoperative outcomes.

Main Methods:

  • Retrospective analysis of 1896 adult cardiac surgery patients (849 with complications).
  • Complications graded using CDC and converted to CCI.
  • Correlation analysis (Spearman's ρ, Fisher's z-transformation) of CCI/CDC with ICU stay, length of stay (LOS), and hospitalization cost.
  • Generalized linear models used to identify outcome predictors.

Main Results:

  • The Comprehensive Complication Index (CCI) showed stronger correlations with ICU stay (ρ=0.786), LOS (ρ=0.465), and hospitalization cost (ρ=0.602) compared to the Clavien-Dindo classification (CDC) (ρ=0.401, ρ=0.342, ρ=0.354, respectively).
  • Pneumonia was the most frequent complication (92.8%).
  • Median CCI score was 0.0.

Conclusions:

  • Both CCI and CDC are valid for assessing postoperative outcomes in cardiac surgery.
  • The CCI demonstrates superior ability to discriminate between varying degrees of ICU stay, LOS, and hospitalization costs compared to CDC.
Abstract

Keywords:
Clavien–Dindo classificationcardiac surgeryclinical outcomecomprehensive complication indexpostoperative complication

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