The Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial

BACKGROUND

Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery.

METHODS

The CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications and cardiovascular, gastrointestinal, infectious, pulmonary, and other complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman's rho-test and compared with standard Fisher's z-transformation.

RESULTS

Between 2015 and 2018, 211 patients underwent laparoscopic (n = 106) or open (n = 105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0-23.5] versus 0 [IQR 0-22.6]; p = 0.755) and subgroups of complications (p > 0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (rs = 0.646 versus rs = 0.628; p = 0.001, difference clinically irrelevant), and reoperations (rs = 0.590 versus rs = 0.599; p = 0.070), and weak correlations for ICU-stay (rs = 0.446 versus rs = 0.440; p = 0.189).

CONCLUSIONS

The CCI is a composite scoring system based on the CDC and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, following abdominal surgery other than gastrectomy. Implementing CCI showed no clinically relevant benefit and caused additional workload compared to CDC for assessing complication burden. Therefore, using the CCI alongside the CDC after gastric cancer surgery is not recommended.

Evaluating the use of Clavien-Dindo classification and Picker Patient Experience Questionnaire as quality indicators in gynecologic endoscopy

PURPOSE

Over the last few decades, laparoscopy has become a standard procedure within gynecological surgery. Validated quality indicators for the determination of the objective (perioperative complications) and subjective (patient satisfaction) quality of treatment as a surrogate parameter for the success of the treatment have so far found no regular application in the clinical routine. The purpose of this study was to evaluate the use of the Clavien-Dindo (CD) classification for postoperative complications and the Picker Patient Experience Questionnaire (PPE-15) as tools in the evaluation of endoscopic therapies in clinical routine.

METHODS

Retrospectively, perioperative complications using the CD classification and patient satisfaction utilizing the PPE-15 were reviewed for a total of 212 consecutive patients at a gynecologic endoscopic referral center (Agaplesion Diakonie Kliniken, Kassel, Germany) in September 2018.

RESULTS

An overall complication rate of 13.21% (28 out of 138 patients) was observed. Five patients (2.36%) had complications grade III and above according to the CD classification system. 138 patients out of 212 chose to answer the PPE-15 (return rate 65.01%). 112 patients (81.16%) reported about problems during their treatment in our hospital in their PPE-15. "Purpose of medicines not explained" was the most mentioned item (28.99%) by patients during their hospital stay.

CONCLUSION

CD classification and PPE-15 may be helpful instruments to evaluate the quality of care in gynecology. The application of both instruments for the assessment of treatment quality in clinical routine should be further investigated in prospective studies.