Development and validation of a new score for measuring post-operative complications

Panwar, Rajesh; Mohapatra, Vedavyas; Raichurkar, Karthik; Sahni, Peush

doi:10.1007/s00423-018-1701-2

Cited by 3 publications

(7 citation statements)

References 10 publications

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“…However, the initial publication describing the scale was rejected[14] and was only finally published in December 2018[15]. The authors claim that it improves on the CCI because the CCI assigns an inappropriately high score to a combination of com-plications: “… a patient who develops two Clavien-Dindo grade II complications gets a higher CCI score than a patient who develops a single Clavien-Dindo grade IIIa com-plication…” [15] . The CSS is similar to the CCI in terms of its elaboration and uses a similar formula, but it assigns less weight to each grade of the CDC.…”

Section: Guidelines For the Recording Classification And Comparison mentioning

confidence: 99%

“…Comparing the two new systems, we believe that the CCI should be preferred to the CSS for the following reasons: (1) The preparation of the CCI involved 227 patients and 245 physicians (surgeons, anesthetists and intensivists)[12]. In the preparation of the CSS, only 49 senior gastrointestinal and hepato-pancreatico-biliary surgeons in India were included (“senior” being defined as having at least 5 years of experience after graduating), and no patients[15,23]; and (2) The CCI has a greater diffusion worldwide[13].…”

Section: Guidelines For the Recording Classification And Comparison mentioning

confidence: 99%

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Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

Llamas¹,

Ramia²

2019

WJG

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Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative complications. However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently, two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0 (no complications) to 100 (patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.

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Section: Guidelines For the Recording Classification And Comparison mentioning

confidence: 99%

Section: Guidelines For the Recording Classification And Comparison mentioning

confidence: 99%

Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

Llamas¹,

Ramia²

2019

WJG

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“…The nine CSS survey scenarios further contain only the grade number of the occurred complication (2 Grade II vs. 1 Grade IIIa), but not the actual symptoms or disease pattern as presented in the 30 CCI® scenarios [2]. It is likely that by asking the surgeons Bto choose the patient who had … a more severe complication^ [7] and providing already the severity grade of the respective complication this had a strong impact in their ranking, since the severity level is actually given. The unusually high agreement among surgeons supports our observation that the complication grade guided the physicians' answers.…”

mentioning

confidence: 99%

“…The authors state Ba complication score can only be useful if it is acceptable to surgeons and also correctly defines the patients' outcomes.^ [7] But if the weight of a complication is exclusively based on surgeons' perspective, it does not necessarily fully reflect the patients' viewpoint, which is what ultimately counts at least as much as the surgeons' perspective. It is also intuitive that the overall morbidity may be perceived more serious for a patient suffering from several lower grade complications (e.g., paralytic ileus treated with gastric tube and parenteral nutrition, repetitive bedside wound treatment, and pneumonia treated with an antibiotic) than by a single higher-grade complication (e.g., lower gastrointestinal bleeding treated by colonoscopic hemostasis).…”

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confidence: 99%

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Editorial comment: different perspectives on severity of postoperative morbidity

Staiger

Puhan

Clavien

2018

Langenbecks Arch Surg

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Decreasing postoperative complications remains a challenging objective for all surgeons. To do so, there is the need for adequate recording of all postoperative events, and a grading system by severity. The Clavien-Dindo scale of complications [1] has gained wide acceptance among the surgical community. More recently, a novel metric for morbidity, the Comprehensive Complication Index (CCI®) [2], has been developed and further validated (with values from 0 = no complication to 100 = death) [3, 4] to measure the entire postoperative morbidity from the day of surgery until the majority of all complications are expected to have occured (e.g., 3 months after liver surgery [5]) or beyond. The strong correlation of the CCI® with total cost reflects the comprehensive nature of the CCI® [6]. In their article, Panwar et al. [7] argue that the CCI® gives Binappropriately high scores^to patients with multiple lower grade complications, compared to one single complication with a higher Clavien-Dindo classification grade. To resolve this issue, they proposed a new measure of postoperative morbidity, the Complication Severity Score (CSS). This score was developed in analogy to the CCI® (also range from 0 to 100) and based on a similar formula. But the CSS differs by the respective weights given to each Clavien-Dindo classification grade. These weights were determined in a survey among 49 abdominal surgeons from India [7]. A limitation of the survey is that only abdominal surgeons but no other health professionals

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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

Ray

Mehta

Mangla

et al. 2019

Journal of Surgical Research

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Development and validation of a new score for measuring post-operative complications

Abstract: The CSS more often matched the opinion of experienced senior surgeons compared to CCI. The modified CSS significantly correlated with other patient-centered outcomes.

Cited by 3 publications

References 10 publications

Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

Editorial comment: different perspectives on severity of postoperative morbidity

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

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