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. 2025 Apr 18;25(1):299.
doi: 10.1186/s12872-025-04754-0.

Application of the comprehensive complication index and Clavien-Dindo complication classification in cardiac surgery: a retrospective study

Zhen-Rong Zhang  1 , Yang-Zheng Li  2 , Xiao-Qing Wu  1 , Wen-Jun Chen  1 , Jie-Yang Yuan  1 , Min Yan  1
Affiliations

Application of the comprehensive complication index and Clavien-Dindo complication classification in cardiac surgery: a retrospective study

Zhen-Rong Zhang et al. BMC Cardiovasc Disord. .

Erratum in

Abstract

Background: Standardized tools are needed to accurately assess the severity of postoperative complications in cardiac surgery, which is critical for patient management and outcome evaluation. This study aims to evaluate the application of the Clavien Dindo Complications Classification (CDCC) and Comprehensive Complications Index (CCI) in cardiac surgery.

Results: 563 patients (76.3%) had at least one complication. The mean CCI was 22.5 ± 19.3. Patients who underwent more complex surgeries had higher CDCC grades and CCI scores. Hospitalization cost and length of stay increased with increasing CDCC grade and CCI score. The ACCI (OR: 1.334 [1.109-1.606], p = 0.002) and LVEF (OR: 0.965 [0.943-0.987], p = 0.002) were associated factors for the most severe complications. The CCI may reduce the required sample size by 20.5 times and 19.6 times compared with the most severe complication or major adverse cardiovascular and cerebrovascular events, respectively, as an endpoint.

Conclusion: The CCI and CDCC can help reflect the complexity of cardiac surgery and the burden of hospitalization, providing a more accurate assessment of surgical complications. This may reduce the sample size needed for clinical trials, thus facilitating research in cardiac surgery.

Clinical trial registration: Chinese Clinical Trial Registry (No. ChiCTR2400084925) on May 28th, 2024. https://www.chictr.org.cn/showproj.html?proj=228499 .

Keywords: Cardiac surgery; Clavien–Dindo complication classification; Complications; Comprehensive complication index.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Medical Ethics Committee of Sir Run Run Shaw Hospital (No. 0257). Patient consent was waived by the ethics committee considering that no intervention on the participants was intended. All participants were 18 years old or older. Furthermore, the anonymization of participants’ personal information was guaranteed. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of case inclusion study. CABG, coronary artery bypass grafting
Fig. 2
Fig. 2
Comparison of the highest CDCC (black bars) with the cumulative CCI (red line) for each patient
Fig. 3
Fig. 3
Box-and-whisker plot illustrating the CCI for calculating the quantitative morbidity sustained during postoperative evolution on the basis of the severity and number of complications relative to the type of surgery. AVR, aortic valve replacement; CABG, coronary artery bypass grafting; MV, mitral valve; TV, tricuspid valve
Fig. 4
Fig. 4
Association between patient CDCC grade and postoperative burden. * p < 0.05 compared with patients without complications; * * * p < 0.001 compared with patients without complications; LOS, length of hospital stay
Fig. 5
Fig. 5
Relationships among the CDCC grade, CCI score, and hospitalization burden. ***, p < 0.001; LOS, length of hospital stay
Fig. 6
Fig. 6
ROC curves: true positive (sensitivity) and false positive (1-specificity) values of the ACCI (AUC = 0.709, 95% CI:0.648–0.770, p = 0.003) and LVEF (AUC = 0.626, 95% CI: 0.562–0.689, p < 0.001) according to the most severe complications (CDCC ≥ IIIb). ACCI, age-adjusted Charlson Comorbidity Index; AUC, area under the curve; LVEF, left ventricular ejection fraction
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