A Comparison Between the Comprehensive Complication Index and the Clavien-Dindo Grading as a Measure of Postoperative Outcome in Patients Undergoing Gastrointestinal Surgery—A Prospective Study

Ray, Samrat; Mehta, Naimish; Mangla, Vivek; Lalwani, Shailendra; Mehrotra, Siddharth; Chugh, Parul; Yadav, Amitabh; Nundy, Samiran

doi:10.1016/j.jss.2019.06.093

Cited by 19 publications

(11 citation statements)

References 16 publications

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“…A comparison of the two scoring systems has been already applied in several studies investigating broad case-mix and heterogeneous populations [8,10,11,[18][19][20]. However, different types of surgical procedures expose patients to peculiar complications and different risks according to the technical details, magnitude of injury, and baseline characteristics of the population.…”

Section: Discussionmentioning

confidence: 99%

“…By this computation CCI appears more precise to capture the overall morbidity burden [8,9]. However, comparison of the two scoring systems have been mostly applied in studies with substantial case-mix and heterogeneous populations [10][11][12]. As it may be more desirable to analyze populations with defined intervention-specific complications, we aimed to assess the performance of CCI and CDC in predicting LOS and excessive LOS (e-LOS) in patients undergoing liver resection for HCC.…”

Section: Introductionmentioning

confidence: 99%

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Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Giani

Cipriani

Famularo

et al. 2020

Cancers

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Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Giani

Cipriani

Famularo

et al. 2020

Cancers

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“…The calculation was performed based on the assumption that a type I error had a probability of 0.05 and power of 0.8. From previous studies in patients undergoing gastrointestinal surgery, which variously reported the incidence of major complications as 14.2% [20] and 28.6% [21], we assumed that the probability of major complications was 0.15. The correlation coefficient between measured and predicted CRP levels was assumed to be 0.83 (1/1.2 � 0.83), and the odds ratio of major complications with CRP levels > an obtained cut-off value relative to those �the cut-off value was estimated to be 3, based on the previous study on predicting CRP levels on POD1 [16].…”

Section: Sample Size Calculationmentioning

confidence: 99%

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

et al. 2020

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Background Postoperative serum concentration of C-reactive protein (CRP) is one of the objective quantitative indices integrating the effects of preoperative and intraoperative variables. Higher levels of CRP after gastrointestinal surgery are associated with major postoperative complications. To develop a model for predicting CRP levels on postoperative day (POD) 1 in surgical patients both with and without serious conditions and comorbidities, we modified the previous formula for prediction of CRP levels on POD1, and assessed the accuracy of our modified predictive formula for CRP levels. Material and methods Consecutive patients of all ages undergoing gastrointestinal surgery under general anesthesia were enrolled in this single-institution prospective cohort study. We developed a modified predictive formula in a calculation cohort. Next, associations between measured CRP levels on POD1, predicted CRP levels on POD1 using the previous and modified models, and major complications after surgery were examined in a validation cohort. Results We obtained the following model in the calculation cohort (n = 222): Modified model for predicting CRP levels on POD1 (mg•dL-1) =-10.13 + 0.0025 Duration of surgery (min) + 15.9 Mean Nociceptive Response (NR) + 0.66 Preoperative CRP level (mg•dL-1). In the validation cohort (n = 440), there was a significant association between measured and predicted CRP levels on POD1 (P < 0.001) No significant difference between the measured and predicted CRP levels using the modified model was observed (P = 0.847). There were also significant associations between the predicted CRP levels and major complications after surgery.

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“…Among these variables, the pleura adhesion was classi ed into four types (no, light, medium, and high); tumor location into ve types (the top right, top left, bottom right, bottom left and middle right group); smoking history into two types (non-smoking and more than 10 years). CCI is the Chalson comorbidity index [17]. Constantly, blood samples were measured at 1-7 days before surgery and one day after surgery.…”

Section: Data Collectionmentioning

confidence: 99%

“…Some studies found that elderly patients were more likely to have PCCs [14,15], but a prospective American research suggested that age could not predict the occurrence of major postoperative complications [16], and one patient's physique-related indexes could better predict the occurrence of PCCs. The Charlson Comorbidity Index (CCI) is also a good indicator for evaluating postoperative complications [15,17], and CCI has many overlaps with the criteria for assessing frailty, so both can re ect frailty. In addition, it is still controversial whether intraoperative conversion to thoracotomy and LSHS before surgery can be used as risk factors for PCCs.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors of Complications After Thoracoscopic Lobectomy for Non-Small Cell Lung Cancer-A Retrospective Study

Wang

Xia

Yin

et al. 2021

Preprint

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Background: Video-assisted thoracoscopic surgery, safe and minimally invasive, is the first strategy recommended for non-small cell lung cancer. The purpose of this study was to determine the risk factors for postoperative cardiopulmonary complications (including cardiac and pulmonary complications) in patients with NSCLC who underwent video-assisted thoracoscopic surgery (VATS).Methods: We retrospectively collected information of 3142 lung cancer patients undergoing VATS tumor resection at Jiangsu Provincial People's Hospital from January 2017 to June 2018, and established a clinical prediction model using the factors selected by univariate analysis.Results: A total of 305 in 3142 patients developed postoperative cardiopulmonary complications. In univariate analysis, age, PNI, CCI, long-term smoking history before surgery, conversion to thoracotomy, albumin before surgery, pre-albumin, Δalbumin and pleura adhesion were all associated with cardiac and pulmonary complications. Multivariate analysis showed that age, PNI, CCI, long-term smoking history before surgery, conversion to thoracotomy, pre-albumin, Δalbumin were important independent risk factors for complications. Finally, age, PNI, CCI, long-term smoking history before surgery, conversion to thoracotomy, Δalbumin variables were included in the model (AUC=0.743).Conclusion: Nutritional status (PNI, pre-albumin), CCI, age, long-term smoking history before surgery, conversion to thoracotomy were all independent risk factors for postoperative complications and poor prognosis. Experienced surgeons should instruct the operation of high-risk patients to avoid long-term hospitalization and possible poor prognosis after surgery.

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A Comparison Between the Comprehensive Complication Index and the Clavien-Dindo Grading as a Measure of Postoperative Outcome in Patients Undergoing Gastrointestinal Surgery—A Prospective Study

Cited by 19 publications

References 16 publications

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

Prognostic Factors of Complications After Thoracoscopic Lobectomy for Non-Small Cell Lung Cancer-A Retrospective Study

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