Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma

Alessandro Giani(University of Milano-Bicocca), Federica Cipriani(IRCCS Ospedale San Raffaele), Simone Famularo(Humanitas University), Matteo Donadon(Humanitas University), Davide Paolo Bernasconi(University of Milano-Bicocca), Francesco Ardito(Università Cattolica del Sacro Cuore), Federico Fazio, Daniele Nicolini, Pasquale Perri(Istituti di Ricovero e Cura a Carattere Scientifico), Mario Giuffrida(University of Parma), Nicholas Pontarolo(University of Pavia), Matteo Zanello(IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola), Quirino Lai(Policlinico Umberto I), Simone Conci(University of Verona), Sarah Molfino(University of Brescia), Paola Germani(University of Trieste), Enrico Pinotti, Maurizio Romano(University of Padua), Giuliano La Barba(Ospedale G.B. Morgagni - L.Pierantoni), Cecilia Ferrari(Ospedale San Paolo), Stefan Patauner(Ospedale di Bolzano), Alberto Manzoni(Fondazione Poliambulanza Istituto Ospedaliero), Ivano Sciannamea, Luca Fumagalli(Aziende Socio Sanitarie Territoriali di Lecco), Albert Troci(Luigi Sacco Hospital), Valentina Ferraro, Antonio Floridi(Azienda Ospedaliera Ospedale Maggiore), Fabrizio Romano(Azienda Ospedaliera San Gerardo), Cristina Ciulli(Azienda Ospedaliera San Gerardo), Marco Braga(University of Milano-Bicocca), Francesca Ratti(IRCCS Ospedale San Raffaele), Guido Costa(Humanitas University), Francesco Razionale(Università Cattolica del Sacro Cuore), Nadia Russolillo, Laura Marinelli, Valerio De Peppo(Istituti di Ricovero e Cura a Carattere Scientifico), Elena Cremaschi(University of Parma), Francesco Calabrese(University of Pavia), Zoe Larghi Laureiro(Policlinico Umberto I), Giovanni Lazzari(University of Verona), Davide Cosola(University of Trieste), Mauro Montuori, Luca Salvador(University of Padua), Alessandro Cucchetti(Ospedale G.B. Morgagni - L.Pierantoni), Angelo Franceschi(Ospedale San Paolo), Michele Ciola(Ospedale di Bolzano), Valentina Sega(Fondazione Poliambulanza Istituto Ospedaliero), Pietro Calcagno(Aziende Socio Sanitarie Territoriali di Lecco), Luca Pennacchi(Luigi Sacco Hospital), Michele Tedeschi, Riccardo Memeo, Michele Crespi(Luigi Sacco Hospital), Marco Chiarelli(Aziende Socio Sanitarie Territoriali di Lecco), Adelmo Antonucci, Giuseppe Zimmitti(Fondazione Poliambulanza Istituto Ospedaliero), Antonio Frena(Ospedale di Bolzano), Andrea Percivale(Ospedale San Paolo), Giorgio Ercolani(Ospedale G.B. Morgagni - L.Pierantoni), Giacomo Zanus(University of Padua), Mauro Zago(Aziende Socio Sanitarie Territoriali di Lecco), Paola Tarchi(University of Trieste), Gian Luca Baiocchi(University of Brescia), Andrea Ruzzenente(University of Verona), Massimo Rossi(Policlinico Umberto I), Elio Jovine(IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola), Marcello Maestri(University of Pavia), Raffaele Dalla Valle(University of Parma), Gian Luca Grazi(Istituti di Ricovero e Cura a Carattere Scientifico), Marco Vivarelli, Alessandro Ferrero, Felice Giuliante(Università Cattolica del Sacro Cuore), Guido Torzilli(Humanitas University), Luca Aldrighetti(IRCCS Ospedale San Raffaele), Luca Gianotti(Azienda Ospedaliera San Gerardo)
Cancers
December 21, 2020
10.3390/cancers12123868
Cited by 57Open Access
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Abstract

BACKGROUND: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. METHODS: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. RESULTS: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. CONCLUSIONS: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

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