Department of General Surgery, Jinling Hospital, Nanjing Medical University, East Zhongshan Road, 305, Nanjing, 210002, China.
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, 210002, China.
J Gastrointest Surg. 2018 Sep;22(9):1593-1602. doi: 10.1007/s11605-018-3786-x. Epub 2018 May 15.
The comprehensive complication index (CCI) is a novel approach to evaluate complications. However, application of the CCI in inflammatory bowel disease (IBD) population is scarce and the difference between the CCI and the Clavien-Dindo classification (CDC) remains unknown. The aim of this study was to compare the CCI to the conventional CDC by applying the CCI among the IBD patients.
The data of 426 IBD patients who underwent surgery between September 1, 2015 and August 31, 2017 were collected. Univariate and multivariate analyses were conducted to identify risk factors for postoperative complications. The efficacy of CCI and CDC was compared using correlation analysis and logistic regression. Cumulative sum control (CUSUM) models were applied to monitor the CCI continuously.
Totally, 297 complications occurred in 144 (33.8%) patients. The rate of severe complications (CDC grade ≥ III) was 12.9% and the mean CCI was 9.8 ± 15.5. Preoperative glucocorticoids usage and previous abdominal surgery were related to higher CCI value (p = 0.002, p = 0.006, respectively) but not related to higher incidence of severe complications (CDC grade ≥ III) (p = 0.117, p = 0.177, respectively). In patients with multiple complications, the CCI demonstrated a stronger correlation with hospital stay (ρ = 0.604, p < 0.001) than CDC (ρ = 0.508, p < 0.001). Higher CCI value (p < 0.001, OR 1.161, 95% CI 1.093-1.234) and the CDC grade (p < 0.001, OR 3.811, 95% CI 2.283-6.362) were risk factors for prolonged LOS. In the CUSUM-CCI model of IBD surgery, a gradual decrease was observed over time.
The CCI and the CDC are both risk factors for prolonged postoperative LOS after surgery for IBD patients. The CCI is more strongly correlated with postoperative LOS than is the conventional CDC. The CUSUM-CCI model is effective in monitoring surgical quality.
综合并发症指数（CCI）是一种评估并发症的新方法。然而，CCI 在炎症性肠病（IBD）人群中的应用尚少，且其与 Clavien-Dindo 分级（CDC）的差异尚不清楚。本研究旨在通过在 IBD 患者中应用 CCI 来比较 CCI 与传统的 CDC。
收集了 2015 年 9 月 1 日至 2017 年 8 月 31 日期间接受手术的 426 例 IBD 患者的数据。进行单变量和多变量分析以确定术后并发症的危险因素。使用相关分析和逻辑回归比较 CCI 和 CDC 的效果。应用累积和控制（CUSUM）模型连续监测 CCI。
共有 144 例（33.8%）患者发生 297 种并发症。严重并发症（CDC 分级≥III 级）发生率为 12.9%，平均 CCI 为 9.8±15.5。术前使用糖皮质激素和既往腹部手术与更高的 CCI 值相关（p=0.002，p=0.006），但与严重并发症（CDC 分级≥III 级）发生率无关（p=0.117，p=0.177）。在发生多种并发症的患者中，CCI 与住院时间的相关性（ρ=0.604，p<0.001）强于 CDC（ρ=0.508，p<0.001）。较高的 CCI 值（p<0.001，OR 1.161，95%CI 1.093-1.234）和 CDC 分级（p<0.001，OR 3.811，95%CI 2.283-6.362）是延长 LOS 的危险因素。在 IBD 手术的 CUSUM-CCI 模型中，随着时间的推移，观察到逐渐下降。
CCI 和 CDC 都是 IBD 患者手术后延长术后 LOS 的危险因素。CCI 与术后 LOS 的相关性强于传统的 CDC。CUSUM-CCI 模型可有效监测手术质量。
