The Utility of the Comprehensive Complication Index in Demonstrating the Complication Burden and Predicting Length of...

The Comprehensive Complication Index (CCI) is a novel system based on the Clavien-Dindo Classification (CDC), offering a more comprehensive scoring framework for postoperative adverse events by accumulating all occurred complications. This study aimed to evaluate the ability of the CCI to demonstrate the complication burden and predict length of stay (LOS) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP).

Patients who underwent RALP between 2019 and 2025 at a single tertiary-referral academic center were included in the study. Complications were recorded according to the CDC. Descriptive statistics and linear/logistic regression analyses were conducted to reveal the relationship between clinical predictors and RALP outcomes in detail.

A total of 421 patients were included, of whom 118 (28%) developed at least 1 complication. The complication group had higher median blood loss and longer LOS (170 [145-210] vs. 235 [181-300] mL and 3 [2-3] vs. 3 [2-3] days, both P < .001). The correlation of the cumulative CCI with LOS was marginally stronger than that of the highest CDC grade (CCI r = 0.55; CDC r = 0.53; both P < .001). As the 2 indices were nearly collinear (r ≈ 0.99), this difference is small and should be interpreted cautiously; in separate models the adjusted R² for LOS was slightly higher for the CCI (0.30 vs. 0.27). In multivariable analysis, blood loss (β = 0.012, P < .001) and major complications (β = 1.66, P < .001) were independent predictors of prolonged LOS.

The CCI is a reliable index for demonstrating complication burden and is more accurate than the CDC in predicting LOS.