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

Abstract

The aim of this study was to identify a readily available, reproducible, and internationally applicable cost assessment tool for surgical procedures. SUMMARY OF BACKGROUND DATA Strong economic pressure exists worldwide to slow down the rising of health care costs. Postoperative morbidity significantly impacts on cost in surgical patients. The comprehensive complication index (CCI), reflecting overall postoperative morbidity, may therefore serve as a new marker for cost. METHODS Postoperative complications and total costs from a single tertiary center were prospectively collected (2014 to 2016) up to 3 months after surgery for a variety of abdominal procedures (n = 1388). CCI was used to quantify overall postoperative morbidity. Pearson correlation coefficient (rpears) was calculated for cost and CCI. For cost prediction, a linear regression model based on CCI, age, and type of surgery was developed and validated in an international cohort of patients. RESULTS We found a high correlation between CCI and overall cost (rpears = 0.75) with the strongest correlation for more complex procedures. The prediction model performed very well (R = 0.82); each 10-point increase in CCI corresponded to a 14% increase to the baseline cost. Additional 12% of baseline cost must be added for patients older than 50 years, or 24% for those over 70 years. The validation cohorts showed a good match of predicted and observed cost. CONCLUSION Overall postoperative morbidity correlates highly with cost. The CCI together with the type of surgery and patient age is a novel and reliable predictor of expenses in surgical patients. This finding may enable objective cost comparisons among centers, procedures, or over time obviating the need to look at complex country-specific cost calculations (www.assessurgery.com).

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

“…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.…”

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

“…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].…”

Benchmarks in Pancreatic Surgery

“…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.…”