• Rajesh Panwar and Peush Sahni.
• Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.
• Ann. Surg. 2017 Aug 22.

ObjectiveThe aim of the present study was to compare the proposed complication severity score (CSS) with comprehensive complication index (CCI) using a questionnaire-based survey of experienced gastrointestinal and hepato-pancreatico-biliary surgeons.BackgroundMorbidity rate has become an important outcome measure, as the mortality rates of most surgical procedures have decreased substantially. The recently developed CCI for measuring complications is a step forward in this process but has some drawbacks. We developed a new scoring system for calculating morbidity and compared it with CCI.MethodsWe designed a questionnaire with 9 scenarios wherein each scenario compared a hypothetical patient who developed a number of lower grade complications with another hypothetical patient who underwent the same surgical procedure but developed a single higher grade complication. The questionnaire was sent to 50 experienced surgeons who were asked to choose the patient who in their opinion had more severe complication. The results thus obtained were compared with the CSS and the CCI for these patients.ResultsForty-nine of fifty experienced surgeons replied. Of the 9 sets of scenarios, experienced surgeons' opinion matched with CSS alone in six, CSS as well as CCI in one, and neither CSS or CCI in two scenarios. Of the total 441 responses, 281 matched with CSS while 143 matched with CCI (P = 0.0001, odds ratio: 3.7; 95% CI 2.8-4.8).ConclusionsCCI was not accurate in calculating the severity of a combination of postoperative complications. The CSS more often matched the opinion of experienced senior surgeons but requires further modifications.

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