Comparison of the Comprehensive Complication Index and Clavien-Dindo systems in predicting perioperative outcomes following radical nephroureterectomy

Abstract

Background: Complications can occur following radical nephroureterectomy (RNU) in 20-40% of patients. The Comprehensive Complication Index (CCI) is an alternative grading system to the Clavien-Dindo (CD) grading system that aggregates all complications experienced by a patient on a continuous (as opposed to categorical) scale. We investigate whether the cumulative nature of CCI renders it superior to CD in predicting perioperative course after RNU. Methods:The records of 596 patents who underwent RNU at 7 academic medical centers from 2005 to 2015 were reviewed. Complications occurring within 30 days of RNU were annotated using both the CD and CCI classification systems. Logistic regression was used to determine associations between CD and CCI with perioperative covariates as well as measures of convalescence [hospital length of stay (LOS) and readmission].Results: A total of 377 men and 219 women with a median age of 71, BMI of 27, and Charlson comorbidity score of 4 were included. Over half underwent a minimally invasive RNU. Median LOS following RNU was 6.0 days (range, 1-37 days) and readmission within 30-days occurred in 45 (8%) patients. Overall, 136 patients (23%) experienced a post-operative complication with 91 having a single complication and 45 with multiple (range, 2-6); 44 (7%) patients had Clavien III or greater complications, and the median CCI for those patients experiencing a complication was 20.9 (range, 8.7-100). Both the upper quartile of CCI (≥75th %) and major CD complications were associated with higher baseline Charlson score, ECOG ≥2, and CKD stage ≥ III (all P<0.05). However, only the upper quartile of CCI was associated with LOS (8.9 vs. 5.4 days, P<0.01) and hospital readmission (OR 3.2, 95% CI: 1.9-5.6, P=0.02) after RNU. Conclusions:The CD and CCI classification systems both are associated with similar baseline and perioperative characteristics for RNU patients. However, the cumulative nature of the CCI allows for superior prediction of postoperative course after RNU including LOS and readmission.

Age and ECOG Performance Status as Predictors of Survival of Patients with Upper Urinary Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy

“…In our study, a total number of 106 (106/194, 54.6%) suffered from a perioperative complication according to CDC (I-V). Compared to complication rates of other studies, ranging from 20 to 50% [19][20][21][22], our overall com-plication rate meets the upper margin, most likely because of an older patient clientele due to being a referral center. Complications were significantly increased in the eldest cohorts 3 (80-84 years) and 4 (≥85 years) with complication rates of 92.6% and 87.5%, respectively, compared to cohorts 1 (43.4%) and 2 (56.1%).…”

Observation of complications assessed by Clavien-Dindo classification in different endoscopic procedures of benign prostatic hyperplasia: An observational study

“…For example, a lower incidence of complications was observed in a study because only urological complications with ≥ grade III were included to analyze as the study parameters. [ 26 ] While, a much higher overall incidence of complication was presented in another study owing to the inclusion of many minor complications with grade I to II. [ 27 ] These deviations in the selection and definition of complications frequently appeared in many literature reports, so how to identify and involve grade I to II still requires to be explored in future studies.…”

Clinical validation and comparison of the Comprehensive Complication Index and Clavien-Dindo classification in predicting post-operative outcomes after cytoreductive surgery in advanced ovarian cancer

“…The authors demonstrated that severe complications occurred in 17%,25 however, they did not describe the associations between Clavien-Dindo classification or CCI with surgical outcomes. Studies of non-gynecological surgery have shown that the increasing severity of CCI was associated with intensive care unit admission, prolonged length of hospital stay, and readmission after surgery 14 26 27. A study of major abdominal surgery (n=206) reported the median CCI of 20.9 points (range 0–44.9) and Clavien-Dindo classification grade 2 complications were the most common.…”

“…This therapeutic-based system greatly facilitated a standardized and reproducible measurement of post-operative complications. As a result, it is accepted in surgical fields and additionally validated by the European Association of Urology as a standard classification for evaluating post-operative complications for urological surgeries 14. Nevertheless, the Clavien-Dindo classification has limitations, especially in patients with multiple complications.…”