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Observational Study
. 2021 Jan 1;273(1):112-120.
doi: 10.1097/SLA.0000000000003308.

The Cost of Postoperative Complications and Economic Validation of the Comprehensive Complication Index: Prospective Study

Roberto de la Plaza Llamas  1 , Álvaro Hidalgo Vega  2 , Raquel A Latorre Fragua  1 , Aylhín J López Marcano  1 , Aníbal A Medina Velasco  1 , Daniel A Díaz Candelas  1 , José M García Gil  1 , José M Ramia Ángel  1
Affiliations
Observational Study

The Cost of Postoperative Complications and Economic Validation of the Comprehensive Complication Index: Prospective Study

Roberto de la Plaza Llamas et al. Ann Surg. .

Abstract

Objective: To validate the Comprehensive Complication Index (CCI) via an assessment of its relation to postoperative costs.

Background: The CCI summarizes all the postoperative complications graded by the Clavien-Dindo classification (CDC) on a numerical scale. Its relation to hospital costs has not been validated to date.

Methods: Prospective observational cohort study, including all patients undergoing surgery at a general surgery service during the 1-year study period. All complications graded with the CDC and CCI and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. The surgeries were classified according to their Operative Severity Score (OSS) and in 4 groups of homogeneous surgeries. All postoperative costs were recorded.

Results: In all, 1850 patients were included, of whom 513 presented complications (27.7%). The CDC and the CCI were moderately to strongly correlated with overall postoperative costs (OPCs) in all OSS groups (rs = 0.444-0.810 vs 0.445-0.820; P < 0.001), homogeneous surgeries (rs = 0.364-0.802 vs 0.364-0.813; P < 0.001), prolongation of postoperative stay (rs = 0.802 vs 0.830; P < 0.001), and initial operating room costs (rs = 0.448 vs 0.451; P < 0.001). This correlation was higher in emergency surgery. With higher CDC grades, the OPC tended to increase an upward trend. In the multivariate analysis, CDC, CCI, age, and duration of surgery were all associated with OPC (P < 0.001).

Conclusions: In our environment, the CCI presented associations with OPC. This demonstration of its economic validity enhances its clinical validity.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

References

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    1. de la Plaza Llamas R, Ramia Ángel JM, Bellón JM, et al. Clinical validation of the comprehensive complication index as a measure of postoperative morbidity at a surgical department: a prospective study. Ann Surg 2018; 268:838–844.
    1. Clavien PA, Vetter D, Staiger RD, et al. The comprehensive complication index (CCI®): added value and clinical perspectives 3 years ‘down the line’. Ann Surg 2017; 265:1045–1050.

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