The Assessment of Complications After Major Abdominal Surgery: A Comparison of Two Scales

Jelena Veličković; Chen Feng; Ivan Palibrk; Dejan Veličković; Bojan Jovanović; Vesna Bumbaširević

doi:10.1016/j.jss.2019.10.003

The Assessment of Complications After Major Abdominal Surgery: A Comparison of Two Scales

J Surg Res. 2020 Mar:247:397-405. doi: 10.1016/j.jss.2019.10.003. Epub 2019 Oct 29.

Authors

Jelena Veličković¹, Chen Feng², Ivan Palibrk³, Dejan Veličković³, Bojan Jovanović⁴, Vesna Bumbaširević⁴

Affiliations

¹ Intensive Care Unit, Clinical Center of Serbia, Clinic for Digestive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: [email protected].
² H.Milton Stewart School of Industrial & Systems Engineering, Institute of Technology, Atlanta, Georgia, USA.
³ Intensive Care Unit, Clinical Center of Serbia, Clinic for Digestive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.
⁴ School of Medicine, University of Belgrade, Belgrade, Serbia; Clinical Center of Serbia, Department of Anesthesiology, Belgrade, Serbia.

PMID: 31676144
DOI: 10.1016/j.jss.2019.10.003

Abstract

Background: An accurate and reproducible method for the evaluation of postoperative morbidity is essential for a valid assessment of the outcomes of surgery. However, there is still no consensus on reporting of complications. The Clavien-Dindo classification (CDC) of complications is a validated system which reports only the most severe complication. The Comprehensive Complication Index (CCI) is a novel scale designed to capture the overall burden of complications. The aim of our study is to validate and compare the CDC and the CCI in the setting of high-risk surgical patients in whom multiple complications are common.

Methods: A prospective, observational study analyzed 206 high-risk adult patients undergoing major abdominal surgery. Each postoperative complication was recorded until discharge or readmission within 30 days. The severity of complications was graded with the CDC, and the CCI was calculated subsequently. Correlations of the CDC and the CCI with hospitalization indicators and functional activity on discharge were assessed and compared.

Results: A total of 424 complications occurred in 125 (60.7%) patients. The median CCI for the cohort was 20.9 (0-44.9). CD grade II was the most frequent among patients with complications (62/125; 49.6%). The CCI and the CDC have shown a strong correlation (r = 0.969, P < 0.01). Both scales strongly correlated with the parameters of hospitalization, but the CCI showed a stronger correlation to the intensive care unit length of stay (LOS; 0.670 versus 0.628, P < 0.001), postoperative LOS (0.652 versus 0.630, P = 0.041), and prolonged intensive care unit LOS (0.604 versus 0.555, P < 0.001). The median CCI and the highest CD grade were significantly different respective to the functional activity on discharge (P < 0.001).

Conclusions: The CDC and the CCI are the effective methods for reporting of complications after major abdominal surgery. The CCI is a more accurate scale for use in high-risk patients and correlates better with the postoperative LOS.

Keywords: Clavien-Dindo classification; High-risk patient; Major abdominal surgery; Postoperative complications; The Comprehensive Complication Index.

Publication types

Comparative Study
Observational Study
Validation Study

MeSH terms

Abdomen / surgery*
Aged
Female
Humans
Intensive Care Units / statistics & numerical data
Length of Stay / statistics & numerical data
Male
Middle Aged
Patient Readmission / statistics & numerical data
Postoperative Complications / diagnosis
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Prospective Studies
Reproducibility of Results
Risk Assessment / methods
Risk Factors
Severity of Illness Index
Surgical Procedures, Operative / adverse effects*
Time Factors