Evaluating postoperative outcome assessment tools in hepato-pancreato-biliary surgery: A comparative analysis of the comprehensive complication index and Clavien–Dindo classification in a cohort of 1240 patients at a tertiary care center

Abstract

Introduction: The comprehensive complication index (CCI) has emerged as a new tool for reporting postoperative complications. The aim of this study is to evaluate and compare the efficacy of CCI and Clavien–Dindo Classification (CDC) in measuring postoperative outcomes in patients undergoing hepato-pancreato-biliary (HPB) surgery. Materials and methods: In this single-centered, prospective, comparative study conducted between January 2022 and March 2023, 1240 patients underwent HPB surgery, including laparoscopic cholecystectomies and complex HPB surgery. Postoperative complications were evaluated utilizing the CCI and CDC indices, and their relationships with length of ICU stay, hospital stay, and return to activity were compared. Results: A total of 117 patients (9.44%) experienced complications of varying grades. There was a strong correlation between CCI and CDC (r=0.982, P <0.001). Both CCI and CDC demonstrated a strong correlation with the length of hospital stay, ICU stay, and return to normal activity. While CCI showed a better correlation with the length of hospital stay (r=0.706 vs. 0.695) and return to normal activity (r=0.620 vs. 0.611) than CDC, the difference was not statistically significant. Conclusion: CCI exhibited a stronger correlation with the length of stay and return to activity; however, no statistically significant advantage was observed over CDC.