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Giani A, Cipriani F, Famularo S, et al. Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma. Cancers (Basel). 2020;12(12)doi: 10.3390/cancers12123868.
Giani, A., Cipriani, F., Famularo, S., Donadon, M., Bernasconi, D. P., Ardito, F., Fazio, F., Nicolini, D., Perri, P., Giuffrida, M., Pontarolo, N., Zanello, M., Lai, Q., Conci, S., Molfino, S., Germani, P., Pinotti, E., Romano, M., La Barba, G., Ferrari, C., Patauner, S., Manzoni, A., Sciannamea, I., Fumagalli, L., Troci, A., Ferraro, V., Floridi, A., Memeo, R., Crespi, M., Chiarelli, M., Antonucci, A., Zimmitti, G., Frena, A., Percivale, A., Ercolani, G., Zanus, G., Zago, M., Tarchi, P., Baiocchi, G. L., Ruzzenente, A., Rossi, M., Jovine, E., Maestri, M., Dalla Valle, R., Grazi, G., Vivarelli, M., Ferrero, A., Giuliante, F., Torzilli, G., Aldrighetti, L., Gianotti, L., Romano, F., Ciulli, C., Braga, M., Ratti, F., Costa, G., Razionale, F., Russolillo, N., Marinelli, L., De Peppo, V., Cremaschi, E., Calabrese, F., Larghi Laureiro, Z., Lazzari, G., Cosola, D., Montuori, M., Salvador, L., Cucchetti, A., Franceschi, A., Ciola, M., Sega, V., Calcagno, P., Pennacchi, L., & Tedeschi, M. (2020). Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma. Cancers, 12(12), . https://doi.org/10.3390/cancers12123868
Giani, Alessandro, et al. "Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma." Cancers vol. 12,12 (2020). doi: https://doi.org/10.3390/cancers12123868
Giani A, Cipriani F, Famularo S, Donadon M, Bernasconi DP, Ardito F, Fazio F, Nicolini D, Perri P, Giuffrida M, Pontarolo N, Zanello M, Lai Q, Conci S, Molfino S, Germani P, Pinotti E, Romano M, La Barba G, Ferrari C, Patauner S, Manzoni A, Sciannamea I, Fumagalli L, Troci A, Ferraro V, Floridi A, Memeo R, Crespi M, Chiarelli M, Antonucci A, Zimmitti G, Frena A, Percivale A, Ercolani G, Zanus G, Zago M, Tarchi P, Baiocchi GL, Ruzzenente A, Rossi M, Jovine E, Maestri M, Dalla Valle R, Grazi G, Vivarelli M, Ferrero A, Giuliante F, Torzilli G, Aldrighetti L, Gianotti L, Romano F, Ciulli C, Braga M, Ratti F, Costa G, Razionale F, Russolillo N, Marinelli L, De Peppo V, Cremaschi E, Calabrese F, Larghi Laureiro Z, Lazzari G, Cosola D, Montuori M, Salvador L, Cucchetti A, Franceschi A, Ciola M, Sega V, Calcagno P, Pennacchi L, Tedeschi M. Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma. Cancers (Basel). 2020 Dec 21;12(12). doi: 10.3390/cancers12123868. PMID: 33371419; PMCID: PMC7767420.
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Cancers (Basel). 2020 Dec 21;12(12). doi: 10.3390/cancers12123868.

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

Cancers

Alessandro Giani, Federica Cipriani, Simone Famularo, Matteo Donadon, Davide P Bernasconi, Francesco Ardito, Federico Fazio, Daniele Nicolini, Pasquale Perri, Mario Giuffrida, Nicholas Pontarolo, Matteo Zanello, Quirino Lai, Simone Conci, Sarah Molfino, Paola Germani, Enrico Pinotti, Maurizio Romano, Giuliano La Barba, Cecilia Ferrari, Stefan Patauner, Alberto Manzoni, Ivano Sciannamea, Luca Fumagalli, Albert Troci, Valentina Ferraro, Antonio Floridi, Riccardo Memeo, Michele Crespi, Marco Chiarelli, Adelmo Antonucci, Giuseppe Zimmitti, Antonio Frena, Andrea Percivale, Giorgio Ercolani, Giacomo Zanus, Mauro Zago, Paola Tarchi, Gian Luca Baiocchi, Andrea Ruzzenente, Massimo Rossi, Elio Jovine, Marcello Maestri, Raffaele Dalla Valle, GianLuca Grazi, Marco Vivarelli, Alessandro Ferrero, Felice Giuliante, Guido Torzilli, Luca Aldrighetti, Luca Gianotti, Fabrizio Romano, Cristina Ciulli, Marco Braga, Francesca Ratti, Guido Costa, Francesco Razionale, Nadia Russolillo, Laura Marinelli, Valerio De Peppo, Elena Cremaschi, Francesco Calabrese, Zoe Larghi Laureiro, Giovanni Lazzari, Davide Cosola, Mauro Montuori, Luca Salvador, Alessandro Cucchetti, Angelo Franceschi, Michele Ciola, Valentina Sega, Pietro Calcagno, Luca Pennacchi, Michele Tedeschi

Affiliations

  1. School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy.
  2. Hepatobiliary Surgery Division, Ospedale San Raffaele, 20132 Milan, Italy.
  3. Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, Italy.
  4. Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy.
  5. Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00118 Rome, Italy.
  6. Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", 10112 Turin, Italy.
  7. Hepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy.
  8. Division of Hepatobiliarypancreatic surgery, IRCCS-Regina Elena National Cancer Institute, 00119 Rome, Italy.
  9. Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
  10. Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
  11. Department of Surgery, AOU Sant'Orsola Malpighi, IRCCS Azienda Ospedaliera Universitaria, 40141 Bologna, Italy.
  12. Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, 00118 Rome, Italy.
  13. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, Italy.
  14. Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy.
  15. Department of General Surgery, ASUGI, University Hospital of Trieste, 34121 Trieste, Italy.
  16. Department of Surgery, Ponte San Pietro Hospital, 24129 Bergamo, Italy.
  17. Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua; Hepatobiliary and Pancreatic Surgery Unit-Treviso Hospital, 31102 Treviso, Italy.
  18. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, 47122 Forlì, Italy.
  19. HPB Surgical Unit, San Paolo Hospital, 17100 Savona, Italy.
  20. Department of Surgery, Bolzano Central Hospital, 39100 Bolzano, Italy.
  21. Department of General Surgery, Poliambulanza Foundation Hospital, 25136 Brescia, Italy.
  22. Department of Surgery, Monza Polyclinic, 20900 Monza, Italy.
  23. Department of Emergency and Robotic Surgery, ASST Lecco, 23900 Lecco, Italy.
  24. Department of Surgery, L. Sacco Hospital, 20143 Milan, Italy.
  25. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, 70132 Bari, Italy.
  26. Department of General Surgery, ASST Crema, 26013 Crema, Italy.
  27. HPB Unit, Department of Surgery, San Gerardo Hospital, 20900 Monza, Italy.

PMID: 33371419 PMCID: PMC7767420 DOI: 10.3390/cancers12123868

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.

Keywords: Clavien-Dindo classification; comprehensive complication index; hepatocellular carcinoma; length of stay; liver surgery; morbidity; performance

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