Validation of comprehensive complication index in the general surgery department of a small-volume hospital: A prospective observational study

Abstract

Summary: Background/Objective: The comprehensive complication index (CCI) was developed following the Clavien-Dindo classification (CDC) to more properly reflect various complications that occur in one patient. In this study, we performed a prospective observational study to validate the usefulness of CCI in a small-volume hospital. Methods: From March 2017 to February 2018, among the patients who had scheduled surgery with general anesthesia in the Department of Surgery in St. Paul hospital in Korea, 240 patients were enrolled after informed consent. A minor-risk surgery, such as appendectomy, and surgery for inguinal hernia were excluded. The complications were estimated in both CDC and CCI in each patient. Patients were investigated with the EORCT-C30 quality of life questionnaire before and after surgery, and the relationship between CCI score and change in the quality of life was evaluated. Results: There were 26 (10.83%), 41 (17.08%), 8 (3.33%), 3 (1.25%), 4 (1.67%), and 2 (0.83%) patients who were classified as grades I, II, IIIa, IIIb, IVa, and IVb, respectively. The average CCI was 22.94 ± 12.79, and distribution ranged from 8.66 to 76.40. CCI was well distributed in patients with complications more than CDC grade. While there was no correlation between preoperative Charlson comorbidity index with CCI, pain scale, and cognitive scale were aggravated significantly when CCI increased. Conclusion: CCI reflected the complication status with a more detailed distribution compared with CDC. Moreover, CCI had a significant relation with pain and the cognitive function scale. CCI might be a useful complication grading system in a small-volume surgical department. Keywords: Complication, General surgery, Classification, Comorbidity