The Comprehensive Complication Index (CCI®) is a Novel Cost Assessment Tool for Surgical Procedures

Staiger, Roxane D; Cimino, Matteo; Javed, Ammar A.; Biondo, Sebastiano; Fondevila, Constantino; Périnel, Julie; Aragão, Ana Carolina A.; Torzilli, Guido; Wolfgang, Christopher L.; Adham, Mustapha; Marques, Hugo P.; Dutkowski, Philipp; Puhan, Milo A.; Clavien, Pierre Alain

doi:10.1097/sla.0000000000002902

Cited by 81 publications

(85 citation statements)

References 14 publications

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“…29,30 Cost estimation was performed based on recipient age and 90-day CCI score, according to Staigner et al, using a validated online cost-assessment tool for OLT (URL: https ://www.asses surge ry.com/cost-prediction/). 31 Recipient pre-OLT performance status has been assessed using the Karnofsky performance score (KPS). 32 Postoperative transfusions were defined as any blood products given within the first 7 days following OLT.…”

Section: Data Collection and Follow-upmentioning

confidence: 99%

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Czigány

Kramp

Bednarsch

et al. 2020

American Journal of Transplantation

119

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Abbreviations: AASLD American Association for the Study of Liver Diseases AUC area under the curve AUROC area under the receiver operating characteristics curve BAR balance of risk BC body composition BMI body mass index CCI comprehensive complication index CDC lavien-Dindo classification CT computed tomography EAD early allograft dysfunction EASL European Association for the Study of the Liver ECD extended criteria donor FFP unitsfresh frozen plasma units HU Hounsfield unit ICH International Conference on Harmonisation ICU Intensive Care Unit KPS Karnofsky Performance Score MELD Model of End-stage Liver Disease OLT orthotopic liver transplantation RBC units red blood cell units ROC receiver operating characteristics SM-RA skeletal muscle radiation attenuation SMI skeletal muscle index SMM skeletal muscle mass SOFT survival outcomes following liver transplantation TEur Thousand Euros UH-RWTH University Hospital of the RWTH University VFA visceral fat area1 Muscle wasting and alterations of body composition are linked to clinical outcomes in numerous medical conditions. The role of myosteatosis in posttransplant outcomes remains to be determined. Here we investigated skeletal muscle mass and myosteatosis as prognostic factors in patients undergoing orthotopic liver transplantation (OLT). The data of 225 consecutive OLT recipients from a prospective database were retrospectively analyzed (May 2010-December 2017). Computed tomography-based skeletal-muscleindex (muscle mass), visceral-fat-area (visceral adiposity), and mean skeletal-muscle-radiation-attenuation (myosteatosis) were calculated using a segmentation tool. Cut-off values of myosteatosis resulted in a good stratification of patients into low-and high-risk groups in terms of morbidity (Clavien-Dindo ≥3b). Patients with myosteatosis had significantly higher complication rates (90-day Comprehensive Complication Index 68 ± 32vs 44 ± 30, P < .001) and also displayed significantly longer intensive care (18 ± 25 vs 11 ± 21 days, P < .001) and hospital stay (56 ± 55 vs 33 ± 24 days, P < .001). Estimated costs were 44% higher compared to patients without myosteatosis. Multivariable analysis identified myosteatosis as an independent prognostic factor for major morbidity (odds ratio: 2.772, confidence interval: 1.516-5.066, P = .001). Adding myosteatosis to the well-established Balance-of-Risk-(BAR) score resulted in an increased prognostic value compared to the original BAR score. Myosteatosis may be a useful parameter to predict perioperative outcome in patients undergoing OLT, supporting the role of muscle quality (myosteatosis) over quantity (muscle mass) in this setting. K E Y W O R D Sbody composition, clinical decision-making, clinical research/practice, complication, liver transpla...

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Section: Data Collection and Follow-upmentioning

confidence: 99%

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Czigány

Kramp

Bednarsch

et al. 2020

American Journal of Transplantation

119

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“…Patients excluded from the "low-risk" group had a history of previous intraabdominal surgery, cardiovascular disease (e.g., cardiac arrhythmia, stroke, coronary artery disease), history of thromboembolic events and/or therapeutic anticoagulation, diabetes mellitus (type 1 and type 2, as defined by the American Diabetes Association), obstructive sleep apnea (recurrent episodes of upper airway collapse during sleep), chronic obstructive pulmonary disease (FEV1/ FVC < 0.7), chronic kidney disease (eGFR < 30 mL/min/1.72 m2), inflammatory bowel disease (ulcerative colitis, Crohn's disease), immunosuppression therapy (i.e., steroids, calcineurin inhibitors), or associated surgical procedures (i.e., cholecystectomy, hiatoplasty, liver biopsy). Costs were estimated for patients with or without any surgical complications by using the algorithm developed by Staiger et al [24].…”

Section: Study Population and Designmentioning

confidence: 99%

Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Curve

et al. 2020

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Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a technically demanding procedure. The learning curve of LRYGB is challenging and potentially associated with increased morbidity. This study evaluates whether a general laparoscopic surgeon can be safely trained in performing LRYGB in a peripheral setting, by comparing perioperative outcomes to global benchmarks and to those of a senior surgeon. Methods All consecutive patients undergoing primary LRYGB between January 2014 and December 2017 were operated on by a senior (A) or a trainee (B) bariatric surgeon and were prospectively included. The main outcome of interest was all-cause morbidity at 90 days. Perioperative outcomes were compared with global benchmarks pooled from 19 international high-volume centers and between surgeons A and B for their first and last 30 procedures. Results The 213 included patients had a mean all-cause morbidity rate at 90 days of 8% (17/213). 95.3% (203/213) of the patients were uneventfully discharged after surgery. Perioperative outcomes of surgeon B were all within the global benchmark cutoffs. Mean operative time for the first 30 procedures was significantly shorter for surgeon A compared with surgeon B, with 108.6 min (± 21.7) and 135.1 min (± 28.1) respectively and decreased significantly for the last 30 procedures to 95 min (± 33.7) and 88.8 min (± 26.9) for surgeons A and B respectively. Conclusion Training of a new bariatric surgeon did not increase morbidity and operative time improved for both surgeons. Perioperative outcomes within global benchmarks suggest that it may be safe to teach bariatric surgery in peripheral setting.

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“…Coupled to a recent study published in this journal showing a close correlation between CCI 1 and costs, we would expect that the financial burden for PD extends up to 6 months after surgery, which should be taken into account for proper reimbursement. 43 To illustrate the applicability of the established benchmark cutoffs for outcome comparisons with other cohorts undergoing PD, we first analyzed nearly thousand patients, only differing from the benchmark cases by a poorer preoperative physical status (ASA class !3). In this cohort, morbidity rates increased but stayed within the benchmark cutoffs.…”

Section: Discussionmentioning

confidence: 99%

Benchmarks in Pancreatic Surgery

et al. 2019

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OBJECTIVE To use the concept of benchmarking to establish robust and standardized outcome references after pancreatico-duodenectomy (PD). BACKGROUND Best achievable results after PD are unknown. Consequently, outcome comparisons among different cohorts, centers or with novel surgical techniques remain speculative. METHODS This multicenter study analyzes consecutive patients (2012-2015) undergoing PD in 23 international expert centers in pancreas surgery. Outcomes in patients without significant comorbidities and major vascular resection (benchmark cases) were analyzed to establish 20 outcome benchmarks for PD. These benchmarks were tested in a cohort with a poorer preoperative physical status (ASA class 3) and a cohort treated by minimally invasive approaches. RESULTS Two thousand three hundred seventy-five (38%) low-risk cases out of a total of 6186 PDs were analyzed, disclosing low in-hospital mortality (1.6%) but high morbidity, with a 73% benchmark morbidity rate cumulated within 6 months following surgery. Benchmark cutoffs for pancreatic fistulas (B-C), severe complications (grade 3), and failure-to-rescue rate were 19%, 30%, and 9%, respectively. The ASA 3 cohort showed comparable morbidity but a higher in hospital-mortality (3% vs 1.6%) and failure-to-rescue rate (16% vs 9%) than the benchmarks. The proportion of benchmark cases performed varied greatly across centers and continents for both open (9%-93%) and minimally invasive (11%-62%) PD. Centers operating mostly on complex PD cases disclosed better results than those with a majority of low-risk cases. CONCLUSION The proposed outcome benchmarks for PD, established in a large-scale international patient cohort and tested in 2 different cohorts, may allow for meaningful comparisons between different patient cohorts, centers, countries, and surgical techniques.

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The Comprehensive Complication Index (CCI®) is a Novel Cost Assessment Tool for Surgical Procedures

Cited by 81 publications

References 14 publications

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Curve

Benchmarks in Pancreatic Surgery

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