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The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery
PURPOSE: The comprehensive complication index (CCI) is a new tool for reporting the cumulative burden of postoperative complications on a continuous scale. This study validates the CCI for urological surgery and its benefits over the Clavien-Dindo-Classification (Clavien). MATERIAL AND METHODS: Data...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166677/ https://www.ncbi.nlm.nih.gov/pubmed/32813094 http://dx.doi.org/10.1007/s00345-020-03356-z |
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author | Kowalewski, K. F. Müller, D. Mühlbauer, J. Hendrie, J. D. Worst, T. S. Wessels, F. Walach, M. T. von Hardenberg, J. Nuhn, P. Honeck, P. Michel, M. S. Kriegmair, M. C. |
author_facet | Kowalewski, K. F. Müller, D. Mühlbauer, J. Hendrie, J. D. Worst, T. S. Wessels, F. Walach, M. T. von Hardenberg, J. Nuhn, P. Honeck, P. Michel, M. S. Kriegmair, M. C. |
author_sort | Kowalewski, K. F. |
collection | PubMed |
description | PURPOSE: The comprehensive complication index (CCI) is a new tool for reporting the cumulative burden of postoperative complications on a continuous scale. This study validates the CCI for urological surgery and its benefits over the Clavien-Dindo-Classification (Clavien). MATERIAL AND METHODS: Data from a prospectively maintained data base of all consecutive patients at a university care-center was analyzed. Complications after radical cystectomy (RC), radical prostatectomy (RP), and partial nephrectomy (PN) were classified using the CCI and Clavien system. Differences in complications between the CCI and the Clavien were assessed and correlation analyses performed. Sample size calculations for hypothetical clinical trials were compared between CCI and Clavien to evaluate whether the CCI would reduce the number of required patients in a clinical trial. RESULTS: 682 patients (172 RC, 297 RP, 213 PN) were analyzed. Overall, 9.4–46.6% of patients had > 1 complication cumulatively assessed with the CCI resulting in an upgrading in the Clavien classification for 2.4–32.4% of patients. Therefore, scores between the systems differed for RC: CCI (mean ± standard deviation) 26.3 ± 20.8 vs. Clavien 20.4 ± 16.7, p < 0.001; PN: CCI 8.4 ± 14.7 vs. Clavien 7.0 ± 11.8, p < 0.001 and RP: CCI 5.8 ± 11.7 vs. Clavien 5.3 ± 10.6, p = 0.102. The CCI was more accurate in predicting LOS after RC than Clavien (p < 0.001). Sample size calculations based in the CCI (for future hypothetical trials) resulted in a reduction of required patients for all procedures (− 25% RC, − 74% PN, − 80% RP). CONCLUSION: The CCI is more accurate to assess surgical complications and reduces required sample sizes that will facilitate the conduction of clinical trials. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00345-020-03356-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-8166677 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-81666772021-06-03 The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery Kowalewski, K. F. Müller, D. Mühlbauer, J. Hendrie, J. D. Worst, T. S. Wessels, F. Walach, M. T. von Hardenberg, J. Nuhn, P. Honeck, P. Michel, M. S. Kriegmair, M. C. World J Urol Original Article PURPOSE: The comprehensive complication index (CCI) is a new tool for reporting the cumulative burden of postoperative complications on a continuous scale. This study validates the CCI for urological surgery and its benefits over the Clavien-Dindo-Classification (Clavien). MATERIAL AND METHODS: Data from a prospectively maintained data base of all consecutive patients at a university care-center was analyzed. Complications after radical cystectomy (RC), radical prostatectomy (RP), and partial nephrectomy (PN) were classified using the CCI and Clavien system. Differences in complications between the CCI and the Clavien were assessed and correlation analyses performed. Sample size calculations for hypothetical clinical trials were compared between CCI and Clavien to evaluate whether the CCI would reduce the number of required patients in a clinical trial. RESULTS: 682 patients (172 RC, 297 RP, 213 PN) were analyzed. Overall, 9.4–46.6% of patients had > 1 complication cumulatively assessed with the CCI resulting in an upgrading in the Clavien classification for 2.4–32.4% of patients. Therefore, scores between the systems differed for RC: CCI (mean ± standard deviation) 26.3 ± 20.8 vs. Clavien 20.4 ± 16.7, p < 0.001; PN: CCI 8.4 ± 14.7 vs. Clavien 7.0 ± 11.8, p < 0.001 and RP: CCI 5.8 ± 11.7 vs. Clavien 5.3 ± 10.6, p = 0.102. The CCI was more accurate in predicting LOS after RC than Clavien (p < 0.001). Sample size calculations based in the CCI (for future hypothetical trials) resulted in a reduction of required patients for all procedures (− 25% RC, − 74% PN, − 80% RP). CONCLUSION: The CCI is more accurate to assess surgical complications and reduces required sample sizes that will facilitate the conduction of clinical trials. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00345-020-03356-z) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-08-19 2021 /pmc/articles/PMC8166677/ /pubmed/32813094 http://dx.doi.org/10.1007/s00345-020-03356-z Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Kowalewski, K. F. Müller, D. Mühlbauer, J. Hendrie, J. D. Worst, T. S. Wessels, F. Walach, M. T. von Hardenberg, J. Nuhn, P. Honeck, P. Michel, M. S. Kriegmair, M. C. The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery |
title | The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery |
title_full | The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery |
title_fullStr | The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery |
title_full_unstemmed | The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery |
title_short | The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery |
title_sort | comprehensive complication index (cci): proposal of a new reporting standard for complications in major urological surgery |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166677/ https://www.ncbi.nlm.nih.gov/pubmed/32813094 http://dx.doi.org/10.1007/s00345-020-03356-z |
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