Development and validation of a new score for measuring post-operative complications
Assigning a numerical value to post-operative morbidity may improve its usefulness as an outcome measure. The recently developed Comprehensive Complication Index (CCI) is a step forward in this process but assigns an inappropriately high score to a combination of complications.
We developed a new score called the complication severity score (CSS) using a mathematical process and compared it with the CCI using a questionnaire-based survey of 49 experienced gastrointestinal and hepato-pancreatico-biliary surgeons. The CSS was modified based on the results of this survey and was correlated with other patient-centered outcomes in a prospective cohort of consecutive patients undergoing elective surgery.
Of the nine sets of scenarios, experienced surgeons’ opinion matched with CSS in 6, CSS as well as CCI in 1, and neither CSS nor CCI in 2 scenarios. Of the total 441 responses, 281 matched with CSS while 143 matched with CCI (p = 0.0001, odds ratio: 3.7; 95% CI: 2.8 to 4.8). The modified CSS significantly correlated with the post-operative length of stay (r = 0.76; 95% CI: 0.68 to 0.82; p < 0.001), the length of ICU stay (r = 0.61; 95% CI: 0.50 to 0.70; p < 0.001) and with the difference between pre-operative and post-operative quality of life scores in the physical (r = 0.29; 95% CI: 0.14 to 0.42; p < 0.001) and social (r = 0.29; 95% CI: 0.14 to 0.43; p < 0.001) domains.
The CSS more often matched the opinion of experienced senior surgeons compared to CCI. The modified CSS significantly correlated with other patient-centered outcomes.
KeywordsMorbidity Clavien–Dindo Comprehensive complication index Complication severity score Post-operative complications
RP: conceptualization, study planning, data collection & compilation, manuscript preparation, statistical analysis. VM: data collection & compilation. KR: data collection & compilation. PS: study planning, data collection, editing of manuscript. All authors were involved in the drafting of the work and revising it critically for important intellectual content and have approved the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Compliance with ethical standards
The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Conflicts of interest
Authors RP, VM, KR & PS have no conflicts of interest to declare.
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.Slankamenac K, Nederlof N, Pessaux P et al (2014) The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg 260:757–762; discussion 762-763. https://doi.org/10.1097/SLA.0000000000000948 CrossRefGoogle Scholar
- 6.Kim T-H, Suh Y-S, Huh Y-J, Son YG, Park JH, Yang JY, Kong SH, Ahn HS, Lee HJ, Slankamenac K, Clavien PA, Yang HK (2018) The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery. Gastric Cancer 21:171–181. https://doi.org/10.1007/s10120-017-0728-3 CrossRefGoogle Scholar
- 7.Saxena S, Chandiramani K, Bhargava R (1998) WHOQOL-Hindi: a questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life. Natl Med J India 11:160–165Google Scholar
- 9.Rahbari NN, Reissfelder C, Koch M, Elbers H, Striebel F, Büchler MW, Weitz J (2011) The predictive value of postoperative clinical risk scores for outcome after hepatic resection: a validation analysis in 807 patients. Ann Surg Oncol 18:3640–3649. https://doi.org/10.1245/s10434-011-1829-6 CrossRefGoogle Scholar
- 10.Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13. https://doi.org/10.1016/j.surg.2005.05.001 CrossRefGoogle Scholar
- 11.Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768. https://doi.org/10.1016/j.surg.2007.05.005 CrossRefGoogle Scholar