The Comprehensive Complication Index (CCI®) is a Novel Cost Assessment Tool for Surgical Procedures.
- Staiger RD Department of Surgery and Transplantation, University Hospital of Zurich, Zurich, Switzerland.
- Cimino M Department of Surgery & Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, Milan, Italy.
- Javed A Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Biondo S Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain.
- Fondevila C Department of Surgery, Hospital Clinic de Barcelona, Barcelona, Spain.
- Périnel J Department of General and Digestive Surgery, University Hospital of Lyon, Lyon, France.
- Aragão AC Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, CHLC, Lisbon, Portugal.
- Torzilli G Department of Surgery & Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, Milan, Italy.
- Wolfgang C Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Adham M Department of General and Digestive Surgery, University Hospital of Lyon, Lyon, France.
- Pinto-Marques H Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, CHLC, Lisbon, Portugal.
- Dutkowski P Department of Surgery and Transplantation, University Hospital of Zurich, Zurich, Switzerland.
- Puhan MA Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
- Clavien PA Department of Surgery and Transplantation, University Hospital of Zurich, Zurich, Switzerland.
- 2018-10-02
Published in:
- Annals of surgery. - 2018
Health Care Costs
Health Status Indicators
Humans
Postoperative Complications
Prospective Studies
Reproducibility of Results
Risk Assessment
Severity of Illness Index
Surveys and Questionnaires
English
OBJECTIVE
The aim of this study was to identify a readily available, reproducible, and internationally applicable cost assessment tool for surgical procedures.
SUMMARY OF BACKGROUND DATA
Strong economic pressure exists worldwide to slow down the rising of health care costs. Postoperative morbidity significantly impacts on cost in surgical patients. The comprehensive complication index (CCI), reflecting overall postoperative morbidity, may therefore serve as a new marker for cost.
METHODS
Postoperative complications and total costs from a single tertiary center were prospectively collected (2014 to 2016) up to 3 months after surgery for a variety of abdominal procedures (n = 1388). CCI was used to quantify overall postoperative morbidity. Pearson correlation coefficient (rpears) was calculated for cost and CCI. For cost prediction, a linear regression model based on CCI, age, and type of surgery was developed and validated in an international cohort of patients.
RESULTS
We found a high correlation between CCI and overall cost (rpears = 0.75) with the strongest correlation for more complex procedures. The prediction model performed very well (R = 0.82); each 10-point increase in CCI corresponded to a 14% increase to the baseline cost. Additional 12% of baseline cost must be added for patients older than 50 years, or 24% for those over 70 years. The validation cohorts showed a good match of predicted and observed cost.
CONCLUSION
Overall postoperative morbidity correlates highly with cost. The CCI together with the type of surgery and patient age is a novel and reliable predictor of expenses in surgical patients. This finding may enable objective cost comparisons among centers, procedures, or over time obviating the need to look at complex country-specific cost calculations (www.assessurgery.com).
The aim of this study was to identify a readily available, reproducible, and internationally applicable cost assessment tool for surgical procedures.
SUMMARY OF BACKGROUND DATA
Strong economic pressure exists worldwide to slow down the rising of health care costs. Postoperative morbidity significantly impacts on cost in surgical patients. The comprehensive complication index (CCI), reflecting overall postoperative morbidity, may therefore serve as a new marker for cost.
METHODS
Postoperative complications and total costs from a single tertiary center were prospectively collected (2014 to 2016) up to 3 months after surgery for a variety of abdominal procedures (n = 1388). CCI was used to quantify overall postoperative morbidity. Pearson correlation coefficient (rpears) was calculated for cost and CCI. For cost prediction, a linear regression model based on CCI, age, and type of surgery was developed and validated in an international cohort of patients.
RESULTS
We found a high correlation between CCI and overall cost (rpears = 0.75) with the strongest correlation for more complex procedures. The prediction model performed very well (R = 0.82); each 10-point increase in CCI corresponded to a 14% increase to the baseline cost. Additional 12% of baseline cost must be added for patients older than 50 years, or 24% for those over 70 years. The validation cohorts showed a good match of predicted and observed cost.
CONCLUSION
Overall postoperative morbidity correlates highly with cost. The CCI together with the type of surgery and patient age is a novel and reliable predictor of expenses in surgical patients. This finding may enable objective cost comparisons among centers, procedures, or over time obviating the need to look at complex country-specific cost calculations (www.assessurgery.com).
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1097/SLA.0000000000002902
- PMID 30272585
- Persistent URL
- https://folia.unifr.ch/global/documents/191266
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