Comparing the Comprehensive Complication Index and Clavien-Dindo classification for evaluating postoperative complication severity in major abdominal surgery

Abstract

Background: The Clavien-Dindo classification has been widely used to evaluate postoperative complications; however, it captures only the most severe event and may underestimate the overall morbidity burden. The Comprehensive Complication Index, developed to address this limitation, aggregates all complications into a single continuous score. Comprehensive evaluations of the Clavien-Dindo classification and Comprehensive Complication Index across diverse major abdominal surgical procedures are scarce, with most existing studies limited by relatively small cohorts and a focus on specific diseases. Methods: We retrospectively analyzed 824 patients who underwent elective major abdominal surgeries (total gastrectomy, colorectal surgery with liver resection, major hepatectomy, and pancreatoduodenectomy) at a single tertiary center between January 2020 and December 2022. The ClavienDindo classification and Comprehensive Complication Index were calculated for each patient using postoperative data, and their correlation with length of hospital stay and cost was assessed. The correlation power between the Comprehensive Complication Index and Clavien-Dindo classification was compared. Results: Pearson correlation analysis revealed a strong correlation between the Comprehensive Complication Index and Clavien-Dindo classification (r = 0.795, P < .001). When examined in relation to clinical outcomes using correlation coefficients, the Comprehensive Complication Index showed a stronger correlation with length of hospital stay and cost than the Clavien-Dindo classification did (Comprehensive Complication Index versus Clavien-Dindo classification: length of hospital stay (r) 0.770 vs 0.571, P < .001; cost (r) 0.784 vs 0.645, P < .001). Conclusion: The Comprehensive Complication Index shows a stronger correlation with length of hospital stay and costs than the Clavien-Dindo classification did in major abdominal surgeries, supporting its use as a more informative and comprehensive tool for assessing postoperative morbidity. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.