The Comprehensive Complication Index

Slankamenac, Ksenija; Nederlof, Nina; Pessaux, Patrick; Jonge, Jeroen de; Wijnhoven, Bas P. L.; Breitenstein, Stefan; Oberkofler, Christian E.; Graf, Rolf; Puhan, Milo A.; Clavien, Pierre Alain

doi:10.1097/sla.0000000000000948

Cited by 286 publications

(159 citation statements)

References 30 publications

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“…Benchmarking is not restricted to comparative analyses of outcome, but should serve as a mechanism for transforming surgical practice and enhancing quality of care. To further develop this, future studies should include the calculation of the total burden of multiple complications in individual patients by utilising the comprehensive complication index, a factor which is relevant in trauma patients with several injured organs[32]. …”

Section: Discussionmentioning

confidence: 99%

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

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AIMTo benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries.METHODSA prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied.RESULTSOverall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection (PD) were significant.CONCLUSIONThis ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

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Section: Discussionmentioning

confidence: 99%

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

View full text Add to dashboard Cite

show abstract

“…Post-operative complications were calculated using the comprehensive complications index (CCI) based on the Clavien-Dindo classification. 27,28 The CCI is a score ranging from 0 to 100 that takes into account all 30 day complications and their treatment, where 0 indicates no deviation from the expected post-operative course and 100 is death.…”

Section: Methodsmentioning

confidence: 99%

Wireless Monitoring Program of Patient-Centered Outcomes and Recovery Before and After Major Abdominal Cancer Surgery

et al. 2017

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Importance A combined objective and subjective wireless monitoring program of patient-centered outcomes can be carried out in patients before and after major abdominal surgery. Objective To conduct a proof-of-concept study of a wireless, patient-centered outcomes monitoring program before and after major abdominal cancer surgery. Design Patients wore wristband pedometers and completed online patient-reported outcome surveys (symptoms, QOL) 3 to 7 days before surgery, through hospitalization, and for two weeks post-discharge. Alerts were generated for all moderate to severe scores for symptoms and QOL. Surgery-related data was collected via electronic medical chart and complications were calculated using the Clavien-Dindo classification. Setting The study was carried out in the inpatient and outpatient surgical oncology unit of one NCI designated comprehensive cancer center. Participants Eligible patients were scheduled to undergo curative resection for hepatobiliary and gastrointestinal malignancies, English-speaking, and 18 years or older. Twenty participants were enrolled over 4 months. Main Outcomes and Measures Outcomes included 1) adherence with wearing the pedometer; 2) adherence with completing the surveys (MDASI and EQ-5D-5L), and 3) satisfaction with the monitoring program. Results Pedometer adherence (88% pre-op versus 83% post-discharge) was higher than survey adherence (75% completed). The median number of steps at day 7 was 1689 (19% of steps at baseline). This correlated with the comprehensive complication index (CCI), for which the median was 15/100 (r = −0.64, p<0.05). Post-discharge overall symptom severity (2.3/10) and symptom interference with activities (3.5/10) were mild. Pain, fatigue, and appetite loss were moderate after surgery (4.4, 4.7, 4.0). QOL scores were lowest at discharge (66.6/100), but improved at week 2 (73.9/100). While patient-reported outcomes returned to baseline at 2 weeks, the number of steps was only one third of pre-operative baseline. Conclusions and Relevance Wireless monitoring of combined subjective and objective patient-centered outcomes can be carried out in the surgical oncology setting. Pre- and post-operative patient-centered outcomes have the potential of identifying high risk populations who may need additional interventions to support postoperative functional and symptom recovery.

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“…In this study, CCI enabled detection of significant effects of immunonutrition on the rate of severe and/or multiple complications in patients with PDAC, undergoing pancreatuduodenal resection, while the overall complication rate measured by either CDC or CCI did not differ between the groups. Although there are no studies of CCI usage in the evaluation of immunonutrition effects on complication rates, CCI demonstrated increased sensitivity and superiority over traditionally reported morbidity endpoints in a recent clinical trial on patients undergoing pancreatoduodenectomy [33]. CCI was also successfully used to evaluate postoperative complication rate in patients undergoing laparoscopic vs. open pancreatoduodenectomy [34].…”

Section: Discussionmentioning

confidence: 99%

Effects of Immunonutrition on Comprehensive Complication Index in Patients Undergoing Pancreatoduodenectomy

et al. 2020

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Background and objectives: Immunonutrition is recommended by enhanced recovery after surgery in patients undergoing pancreatoduodenectomy for 5–7 days perioperatively as it may reduce the rate of infectious complications. However, data on effect of immunonutrition on the overall complication rate are contradictory and it is not clear, which groups of patients benefit most. The aims of this study are to evaluate the effects of immunonutrition on the overall complication rate and the rate of severe and/or multiple complications in patients with pancreatic tumours stratified according to final histological diagnosis—patients with pancreatic ductal adenocarcinoma (PDAC) vs. other tumours—and nutritional state, using more sensitive Comprehensive Complication Index. Materials and Methods: Seventy consecutive patients scheduled for pancreatoduodenectomy because of pancreatic tumours were randomised into immunonutrition vs. control groups and stratified according to final histological diagnosis and nutritional status. Surgical outcomes were assessed postoperatively using Clavien—Dindo classification (CDC) and Comprehensive Complication Index (CCI). Results: No significant differences in the overall complication rates in immunonutrition vs. control, patients with malnutrition vs. no malnutrition, PDAC vs. other pancreatic tumours groups were detected. However, significant differences in the rates of severe and/or multiple complications in immunonutrition vs. control groups and in PDAC patients segregated according to immunonutrition were obtained using CCI. Conclusions: Patients with PDAC may experience greater benefits of immunonutrition as compared to patients with benign pancreatic diseases or less aggressive tumours, while nutritional status was not a determining factor for the efficacy of immunonutrition.

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The Comprehensive Complication Index

Cited by 286 publications

References 30 publications

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Wireless Monitoring Program of Patient-Centered Outcomes and Recovery Before and After Major Abdominal Cancer Surgery

Effects of Immunonutrition on Comprehensive Complication Index in Patients Undergoing Pancreatoduodenectomy

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