Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Clinical Validation of the Comprehensive Complication Index as a Measure of Postoperative Morbidity at a Surgical Department

A Prospective Study

de la Plaza Llamas, Roberto, MD*; Ramia Ángel, José M., MD, PhD*; Bellón, Juan M., MD, PhD; Arteaga Peralta, Vladimir, MD, PhD*; García Amador, Cristina, MD*; López Marcano, Aylhín J., MD*; Medina Velasco, Aníbal A., MD*; González Sierra, Begoña, MD*; Manuel Vázquez, Alba, MD, PhD*

doi: 10.1097/SLA.0000000000002839

Objective: Using 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.

Background: The 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.

Methods: Observational 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.

Results: A 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+.

Conclusions: The 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.

*Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain

Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Networking Biomedical Research Center on Bioengineering-Biomaterials and Nanomedicine (CIBER-BBN), Alcalá de Henares, Madrid, Spain.

Reprints: Roberto de la Plaza Llamas, MD, Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n, 19002 Guadalajara, Spain. E-mail:

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.