A Quantified Scoring System for Postoperative Complication Severity Compared to the Clavien-Dindo Classification.
OBJECTIVE
Esophagectomies are associated with high morbidity. To assess the complication severity, the Clavien-Dindo classification (CDC) grades the most severe complication. However, it ignores additional complications that are equal or less severe. The comprehensive complication index (CCI) incorporates all complication severities. It might therefore be a better system to assess the severities. The aim of this study was to validate the CCI compared to the CDC.


METHODS
A prospective database was used to analyze 621 patients, who underwent an esophagectomy between 1993 and 2005. The CCI was calculated and the relation with traditional parameters was assessed and compared to the relation of the CDC with these parameters.


RESULTS
Complications occurred in 429 patients (69.1%). The correlation between the CCI and the CDC was r = 0.987, p < 0.01. The relation of the CCI with 3 out of 7 parameters was not significantly different compared to the relation of the CDC (p > 0.05). There was a significantly stronger relation (p < 0.05) of the CCI with length of stay (LOS) (r = 0.663 vs. 0.646), a prolonged LOS (r = 0.542 vs. 0.530), reintervention, (r = 0.437 vs. 0.422) and reoperation rate (0.489 vs. 0.471) than the CDC.


CONCLUSIONS
Therefore, the CCI could be a promising scoring system that could be used to identify risks in surgical patient groups.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Annelijn E
AE
Slaman
Sjoerd M
SM
Lagarde
Suzanne S
SS
Gisbertz
Mark I
MI
van Berge Henegouwen
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index