Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Turk J Gastroenterol. 2023 Oct;34(10):1041-1051. doi: 10.5152/tjg.2023.22756.
BACKGROUND/AIMS: Mathematical integration of all complications from the Clavien-Dindo classification into one number called the comprehensive complication index provides a novel method to capture morbidity. This objective of this study was to compare the evaluations of complications between the novel comprehensive complication index and Clavien-Dindo classification for portal hypertension patients who underwent splenectomy plus pericardial devascularization.
Patients treated with either splenectomy plus simplified pericardial devascularization or splenectomy plus traditional pericardial devascularization were included retrospectively. Correlation and logistic regression analyses of the postoperative hospital stay and total hospitalization expense were compared between the comprehensive complication index and Clavien-Dindo classification. The cumulative sum-comprehensive complication index was generated and compared between operation types.
The Child-Pugh classification at admission, spleen thickness, and intraoperative blood loss were risk factors for high comprehensive complication index. Comprehensive complication index showed a stronger relationship with the postoperative hospital stay and total hospitalization expense than the Clavien-Dindo classification. Logistic regression analysis of the postoperative hospital stay demonstrated that the R2 values for the comprehensive complication index and Clavien-Dindo classification were 0.15 and 0.14, respectively. The cumulative sum-comprehensive complication index graph showed a steady dynamic decrease in the cumulative sum score for the individual operation type, with splenectomy plus simplified pericardial devascularization revealing a more notable decrease than splenectomy plus traditional pericardial devascularization.
Comprehensive complication index is an excellent method to assess postoperative morbidity in portal hypertension patients. The cumulative sum-comprehensive complication index chart can better dynamically monitor and compare different operation types. Splenectomy plus simplified pericardial devascularization is better than splenectomy plus traditional pericardial devascularization at decreasing cumulative sum-comprehensive complication index.
背景/目的：将 Clavien-Dindo 分类中的所有并发症综合为一个数字，即综合并发症指数，为评估发病率提供了一种新方法。本研究的目的是比较新型综合并发症指数与 Clavien-Dindo 分类在门静脉高压症患者脾切除加贲门周围血管离断术中评估并发症的效果。
回顾性纳入接受简化贲门周围血管离断术或传统贲门周围血管离断术治疗的患者。比较综合并发症指数与 Clavien-Dindo 分类对术后住院时间和总住院费用的相关性和逻辑回归分析。生成并比较了手术类型之间的累积和综合并发症指数。
入院时的 Child-Pugh 分级、脾脏厚度和术中出血量是高综合并发症指数的危险因素。综合并发症指数与术后住院时间和总住院费用的相关性强于 Clavien-Dindo 分类。术后住院时间的逻辑回归分析显示，综合并发症指数和 Clavien-Dindo 分类的 R2 值分别为 0.15 和 0.14。累积和综合并发症指数图显示，两种手术类型的累积和评分均呈稳定下降趋势，其中简化贲门周围血管离断术组的下降更为显著。
综合并发症指数是评估门静脉高压症患者术后发病率的一种极好方法。累积和综合并发症指数图可以更好地动态监测和比较不同的手术类型。与传统贲门周围血管离断术相比，简化贲门周围血管离断术更能降低累积和综合并发症指数。
