Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University-SMG Boramae Medical Center, Seoul, Korea.
Gastric Cancer. 2018 Jan;21(1):171-181. doi: 10.1007/s10120-017-0728-3. Epub 2017 Jun 8.
The comprehensive complication index (CCI) integrates all complications of the Clavien-Dindo classification (CDC) and offers a metric approach to measure morbidity. The aim of this study was to evaluate the CCI at a high-volume center for gastric cancer surgery and to compare the CCI to the conventional CDC.
Clinical factors were collected from the prospective complication data of gastric cancer patients who underwent radical gastrectomy at Seoul National University Hospital from 2013 to 2014. CDC and CCI were calculated, and risk factors were investigated. Correlations and generalized linear models of hospital stay were compared between the CCI and CDC. The complication monitoring model with cumulative sum control-CCI (CUSUM-CCI) was displayed for individual surgeons, for comparisons between surgeons, and for the institution.
From 1660 patients, 583 complications in 424 patients (25.5%) were identified. The rate of CDC grade IIIa or greater was 9.7%, and the overall CCI was 5.8 ± 11.7. Age, gender, Charlson score, combined resection, open method, and total gastrectomy were associated with increased CCI (p < 0.05). The CCI demonstrated a stronger relationship with hospital stay (ρ = 0.721, p < 0.001) than did the CDC (ρ = 0.634, p < 0.001). For prolonged hospital stays (≥30 days), only the CCI showed a moderate correlation (ρ = 0.544, p = 0.024), although the CDC did not. The CUSUM-CCI model displayed dynamic time-event differences in individual and comparison monitoring models. In the institution monitoring model, a gradual decrease in the CCI was observed.
The CCI is more strongly correlated with postoperative hospital stay than is the conventional CDC. The CUSUM-CCI model can be used for the continuous monitoring of surgical quality.
综合并发症指数（CCI）综合了 Clavien-Dindo 分类（CDC）的所有并发症，并提供了一种衡量发病率的度量方法。本研究旨在评估高容量胃癌手术中心的 CCI，并将其与传统的 CDC 进行比较。
从 2013 年至 2014 年在首尔国立大学医院接受根治性胃切除术的胃癌患者的前瞻性并发症数据中收集临床因素。计算了 CDC 和 CCI，并调查了危险因素。比较了 CCI 和 CDC 之间的住院时间相关性和广义线性模型。显示了用于单个外科医生、外科医生之间和机构之间比较的累积和控制 CCI（CUSUM-CCI）并发症监测模型。
从 1660 名患者中，在 424 名患者（25.5%）中发现了 583 种并发症。CDC 分级 IIIa 或更高的发生率为 9.7%，总体 CCI 为 5.8±11.7。年龄、性别、Charlson 评分、联合切除术、开放式方法和全胃切除术与 CCI 增加相关（p<0.05）。CCI 与住院时间的相关性（ρ=0.721，p<0.001）强于 CDC（ρ=0.634，p<0.001）。对于住院时间延长（≥30 天），只有 CCI 显示中度相关性（ρ=0.544，p=0.024），而 CDC 没有。CUSUM-CCI 模型显示了个体和比较监测模型中动态时间事件差异。在机构监测模型中，CCI 逐渐下降。
CCI 与术后住院时间的相关性强于传统的 CDC。CUSUM-CCI 模型可用于手术质量的连续监测。
