The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery

Abstract

Purpose The comprehensive complication index (CCI) is a new tool for reporting the cumulative burden of postoperative complications on a continuous scale. This study validates the CCI for urological surgery and its benefits over the Clavien-Dindo-Classification (Clavien). Material and methods Data from a prospectively maintained data base of all consecutive patients at a university care-center was analyzed. Complications after radical cystectomy (RC), radical prostatectomy (RP), and partial nephrectomy (PN) were classified using the CCI and Clavien system. Differences in complications between the CCI and the Clavien were assessed and correlation analyses performed. Sample size calculations for hypothetical clinical trials were compared between CCI and Clavien to evaluate whether the CCI would reduce the number of required patients in a clinical trial. Results 682 patients (172 RC, 297 RP, 213 PN) were analyzed. Overall, 9.4-46.6% of patients had > 1 complication cumulatively assessed with the CCI resulting in an upgrading in the Clavien classification for 2.4-32.4% of patients. Therefore, scores between the systems differed for RC: CCI (mean ± standard deviation) 26.

Robotic-Assisted Versus Conventional Open Partial Nephrectomy (Robocop): A Propensity Score-Matched Analysis of 249 Patients

“…The CCI was calculated based on CDC with the freely available calculator at www.assesssurgery.com. In contrast to the CDC, the CCI provides in general a continuous scale from 0 (no complication) to 100 (death of the patient), allowing an easier comparison between treatment groups [16,17,22,23]. However, due to the low range and small values of the observed CCI in our sample, we additionally categorized the CCI into (a) CCI = 0 meaning no complications; (b) CCI >0 and <26.2 (which marks a IIIa complication on the CDC) reflecting minor complications; and (c) ≥26.2 as a measure of major complications.…”

“…Therefore, the Comprehensive Complication Index (CCI), which is based on the CDC but summarizes the cumulative burden of complications on a continuous scale from zero (no complication) to 100 (death), was tested as an appropriate end point to compare complications between both groups [16, 17]. Furthermore, the CCI was validated of major uro-oncological procedures such as PN, radical prostatectomy, and radical cystectomy [18].…”

Role of Imaging Studies in Evaluating Patients Post Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

“…CRS and HIPEC surgeries can significantly influence the overall disease-free survival in selected patients suffering from peritoneal surface malignancies (PSM) [ 6 ]. The most common causes for post HIPEC complications and readmissions include failure to thrive, infection, and ileus and bowel obstruction (Table 1 ) [ 7 , 8 ]. Our patient presented three years after his initial surgery decreasing the likelihood of these complications being the cause of his symptoms.…”

ROBOCOP II (ROBOtic assisted versus conventional open partial nephrectomy) randomised, controlled feasibility trial: clinical trial protocol

“…The Comprehensive Complication Index (CCI) 39 which was previously validated for major urological surgery and that is based on the Clavien Dindo classification will be used. 40 41 Since several studies showed lack of standardisation when reporting intraoperative and postoperative complications, 42 43 the latter will be assessed according to the EAU guidelines on reporting and grading complications after urologic surgical procedures.…”