The Cost of Postoperative Complications and Economic Validation of the Comprehensive Complication Index
| Autor: | Aníbal Armando Medina Velasco, José Manuel Ramia Ángel, Roberto de la Plaza Llamas, Aylhin Joana López Marcano, Raquel Latorre Fragua, José Manuel García Gil, Daniel A. Díaz Candelas, Alvaro Hidalgo Vega |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Multivariate analysis 03 medical and health sciences Postoperative Complications 0302 clinical medicine Cost of Illness Emergency surgery Humans Medicine Prospective Studies Prospective cohort study Aged business.industry Middle Aged Homogeneous 030220 oncology & carcinogenesis Anesthesia Clinical validity Female 030211 gastroenterology & hepatology Surgery Observational study Complication business Cohort study |
| Zdroj: | Annals of Surgery. 273:112-120 |
| ISSN: | 1528-1140 0003-4932 |
| Popis: | OBJECTIVE To validate the Comprehensive Complication Index (CCI) via an assessment of its relation to postoperative costs. BACKGROUND The CCI summarizes all the postoperative complications graded by the Clavien-Dindo classification (CDC) on a numerical scale. Its relation to hospital costs has not been validated to date. METHODS Prospective observational cohort study, including all patients undergoing surgery at a general surgery service during the 1-year study period. All complications graded with the CDC and CCI and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. The surgeries were classified according to their Operative Severity Score (OSS) and in 4 groups of homogeneous surgeries. All postoperative costs were recorded. RESULTS In all, 1850 patients were included, of whom 513 presented complications (27.7%). The CDC and the CCI were moderately to strongly correlated with overall postoperative costs (OPCs) in all OSS groups (rs = 0.444-0.810 vs 0.445-0.820; P < 0.001), homogeneous surgeries (rs = 0.364-0.802 vs 0.364-0.813; P < 0.001), prolongation of postoperative stay (rs = 0.802 vs 0.830; P < 0.001), and initial operating room costs (rs = 0.448 vs 0.451; P < 0.001). This correlation was higher in emergency surgery. With higher CDC grades, the OPC tended to increase an upward trend. In the multivariate analysis, CDC, CCI, age, and duration of surgery were all associated with OPC (P < 0.001). CONCLUSIONS In our environment, the CCI presented associations with OPC. This demonstration of its economic validity enhances its clinical validity. |
| Databáze: | OpenAIRE |
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