• Roberto de la Plaza Llamas, José M Ramia Ángel, Juan M Bellón, Vladimir Arteaga Peralta, Cristina García Amador, Aylhín J López Marcano, Aníbal A Medina Velasco, Begoña González Sierra, and Alba Manuel Vázquez.
• Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain.
• Ann. Surg. 2018 Nov 1; 268 (5): 838-844.

ObjectiveUsing clinical outcomes, to validate the comprehensive complication index (CCI) as a measure of postoperative morbidity in all patients undergoing surgery at a general surgery department.BackgroundThe Clavien-Dindo classification (CDC) is the most widely used system to assess postoperative morbidity. The CCI is a numerical scale based on the CDC. Once validated, it could be used universally to establish and compare the real postoperative complications of each surgical procedure.MethodsObservational prospective cohort study. All patients who underwent surgery during the 1-year study period were included. All the complications graded with the CDC and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. Surgical procedures were classified according to the operative severity score (OSS) as minor, moderate, major, or major+. The clinical validation of the CCI was performed by assessing its correlation with 4 different clinical outcomes.ResultsA total of 1850 patients were included: 513 (27.7%) presented complications and 101 (5.46%) were readmitted. In the multivariate analysis, the CCI and CDC were associated with postoperative stay, prolongation of postoperative stay, readmission, and disability in all OSS groups (P < 0.001). The CCI was superior to the CDC in all models except for prolongation of stay for OSS moderate and major+.ConclusionsThe CCI can be applied in all the procedures carried out at general surgery departments. It is able to determine the morbidity and allows the comparison of the outcomes at different services.

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