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The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery

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Author(s)
Tae-Han KimYun-Suhk SuhYeon-Ju HuhYoung-Gil SonJi-Ho ParkJun-Young YangSeong-Ho KongHye Seong AhnHyuk-Joon LeeKsenija SlankamenacPierre Alain ClavienHan-Kwang Yang
Keimyung Author(s)
Son, Young Gil
Department
Dept. of Surgery (외과학)
Journal Title
Gastric Cancer
Issued Date
2018
Volume
21
Issue
1
Keyword
MorbidityNeoplasmStomach
Abstract
BACKGROUND:

The comprehensive complication index (CCI) integrates all complications of the Clavien-Dindo classification (CDC) and offers a metric approach to measure morbidity. The aim of this study was to evaluate the CCI at a high-volume center for gastric cancer surgery and to compare the CCI to the conventional CDC.

METHODS:

Clinical factors were collected from the prospective complication data of gastric cancer patients who underwent radical gastrectomy at Seoul National University Hospital from 2013 to 2014. CDC and CCI were calculated, and risk factors were investigated. Correlations and generalized linear models of hospital stay were compared between the CCI and CDC. The complication monitoring model with cumulative sum control-CCI (CUSUM-CCI) was displayed for individual surgeons, for comparisons between surgeons, and for the institution.

RESULTS:

From 1660 patients, 583 complications in 424 patients (25.5%) were identified. The rate of CDC grade IIIa or greater was 9.7%, and the overall CCI was 5.8 ± 11.7. Age, gender, Charlson score, combined resection, open method, and total gastrectomy were associated with increased CCI (p < 0.05). The CCI demonstrated a stronger relationship with hospital stay (ρ = 0.721, p < 0.001) than did the CDC (ρ = 0.634, p < 0.001). For prolonged hospital stays (≥30 days), only the CCI showed a moderate correlation (ρ = 0.544, p = 0.024), although the CDC did not. The CUSUM-CCI model displayed dynamic time-event differences in individual and comparison monitoring models. In the institution monitoring model, a gradual decrease in the CCI was observed.

CONCLUSIONS:

The CCI is more strongly correlated with postoperative hospital stay than is the conventional CDC. The CUSUM-CCI model can be used for the continuous monitoring of surgical quality.
Keimyung Author(s)(Kor)
손영길
Publisher
School of Medicine (의과대학)
Citation
Tae-Han Kim et al. (2018). The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery. Gastric Cancer, 21(1), 171–181. doi: 10.1007/s10120-017-0728-3
Type
Article
ISSN
1436-3291
Source
https://link.springer.com/article/10.1007%2Fs10120-017-0728-3
DOI
10.1007/s10120-017-0728-3
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41515
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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