Background/Aims: 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. Conclusion: Therefore, the CCI could be a promising scoring system that could be used to identify risks in surgical patient groups.

Keywords:
Complication severity, Esophageal cancer, Surgery, Esophagectomy
1.
Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J: Analysis of reduced death and complication rates after esophageal resection. Ann Surg 2001;233:338-344.
2.
McCahill LE, May M, Morrow JB, Khandavalli S, Shabahang B, Kemmeter P, et al: Esophagectomy outcomes at a mid-volume cancer center utilizing prospective multidisciplinary care and a 2-surgeon team approach. Am J Surg 2014;207:380-386; discussion 385-386.
3.
Davies AR, Sandhu H, Pillai A, Sinha P, Mattsson F, Forshaw MJ, et al: Surgical resection strategy and the influence of radicality on outcomes in oesophageal cancer. Br J Surg 2014;101:511-517.
4.
Strasberg SM, Linehan DC, Hawkins WG: The accordion severity grading system of surgical complications. Ann Surg 2009;250:177-186.
5.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
6.
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA: The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013;258:1-7.
7.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al: The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196.
8.
Casadei R, Ricci C, Pezzilli R, Calculli L, D'Ambra M, Taffurelli G, et al: Assessment of complications according to the Clavien-Dindo classification after distal pancreatectomy. JOP 2011;12:126-130.
9.
Seely AJ, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T, et al: Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 2010;90:936-942.
10.
Yoon PD, Chalasani V, Woo HH: Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012. J Urol 2013;190:1271-1274.
11.
Rogmark P, Petersson U, Bringman S, Eklund A, Ezra E, Sevonius D, et al: Short-term outcomes for open and laparoscopic midline incisional hernia repair: a randomized multicenter controlled trial: the ProLOVE (prospective randomized trial on open versus laparoscopic operation of ventral eventrations) trial. Ann Surg 2013;258:37-45.
12.
Slankamenac K, Graf R, Barkun J, Puhan M, Clavien PA: CCI®-Calculator (Internet). AssesSurgery GmbH, 2013. http://www.assessurgery.com/calculator_single/.
13.
Slankamenac K, Nederlof N, Pessaux P, de Jonge J, Wijnhoven BP, Breitenstein S, et al: The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg 2014;260:757-762; discussion 762-763.
14.
Lagarde SM, Maris AK, de Castro SM, Busch OR, Obertop H, van Lanschot JJ: Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer. Br J Surg 2007;94:1521-1526.
15.
Goslings JC, Gouma DJ: What is a surgical complication? World J Surg 2008;32:952.
16.
Pallant J: Correlation; in SPSS Survival Manual: A Step by Step Guide to Data Analysis Using SPSS, ed 4. Crows Nest, Allen & Unwin, 2011, p 134.
17.
Harris DY, McAngus JK, Kuo YF, Lindsey RW: Correlations between a dedicated orthopaedic complications grading system and early adverse outcomes in joint arthroplasty. Clin Orthop Relat Res 2015;473:1524-1531.
18.
Mazeh H, Cohen O, Mizrahi I, Hamburger T, Stojadinovic A, Abu-Wasel B, et al: Prospective validation of a surgical complications grading system in a cohort of 2114 patients. J Surg Res 2014;188:30-36.
19.
Strasberg SM, Hall BL: Postoperative morbidity index: a quantitative measure of severity of postoperative complications. J Am Coll Surg 2011;213:616-626.
20.
Porembka MR, Hall BL, Hirbe M, Strasberg SM: Quantitative weighting of postoperative complications based on the accordion severity grading system: demonstration of potential impact using the American college of surgeons national surgical quality improvement program. J Am Coll Surg 2010;210:286-298.
21.
Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, et al: Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012;379:1887-1892.
22.
Van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BPL, et al: Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366:2074-2084.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.