Comparison of Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) systems for grading of surgical complications in patients with gastroduodenal perforations-a prospective study.
TL;DR
The CCI is a superior predictor of postoperative morbidity and hospital stay compared to CDC, particularly in patients with lower-grade CDC complications, as it more comprehensively reflects the cumulative burden of complications.
Abstract
Objective Gastro-duodenal perforation is a life-threatening surgical emergency associated with high morbidity and mortality, particularly in low- and middle-income countries due to delayed presentation and sepsis. Accurate assessment of postoperative complications is essential for predicting outcomes. While the Clavien-Dindo classification (CDC) is widely used, it records only the highest-grade complication, potentially underestimating overall morbidity. The comprehensive complication index (CCI), a continuous scale incorporating all complications, may provide better prognostic value. Material and Methods This prospective observational study was conducted over 18 months in a tertiary care centre in northern India and included 50 adult patients with gastro-duodenal perforation. Postoperative complications were graded using CDC and quantified using CCI. Associations with length of hospital stay (LOS) were analysed using ANOVA, Pearson's correlation, and multivariate linear regression. Results The mean age was 42.26±12.92 years, with a predominance of male and rural patients. Most participants had CDC Grade 3A complications (72%), with a mean CCI of 32.94±14.82. LOS increased significantly with higher CDC grades and CCI categories (p<0.01). CCI showed a significant moderate correlation with LOS (r=0.444, p=0.001), whereas CDC demonstrated a weak, non-significant correlation (r=0.149, p=0.303). On multivariate analysis, CCI independently predicted LOS (β=0.17, p<0.001), while CDC was not significant. The CCI-based model showed better predictive performance (R2=0.35) compared to the CDC model (R2=0.21). Conclusion The CCI is a superior predictor of postoperative morbidity and hospital stay compared to CDC, particularly in patients with lower-grade CDC complications, as it more comprehensively reflects the cumulative burden of complications.