| Objective:The comprehensive complication index(CCI)is a novel approach to evaluate postoperative complications.It has been promoted and widely used in many surgical fields such as gastric resection,pancreatic surgery,esophageal surgery and others.The comprehensive complication index(CCI)showed better sensitivity and clinical applicability than the Clavien-Dindo classification(CDC),and reduced the sample size required in randomized controlled study(RCT).So far,however,application of the CCI in inflammatory bowel disease(IBD)is scarce and the difference between the CCI and the CDC remained unknown.Therefore,the aim of this study was to compare the both postoperative complications evaluation system by applying the CCI and the conventional CDC among the IBD patients.To choose the more sensitive evaluation method for inflammatory bowel disease surgery in patients with postoperative complications,a more comprehensive reflection of the postoperative complications in patients with surgical disease burden,to be more effective to guide clinical surgeons to perform better perioperative management.Methods:The clinical data of patients with inflammatory bowel disease treated by the surgeons in Jinling hospital affiliated to Nanjing University Medical School was collected between September 1,2015 and August 31,2017.Appropriate inclusion criteria and exclusion criteria was made.Data for demographic characteristics were expressed as mean ± SD or median(range).Kolmogorov-Smirnov method was used to test the normality of the variables.Continuous variables were analyzed using Student-t test or Mann-Whitney U test as appropriate.Categorical variables were compared using ?2 test.Univariate analysis was conducted to detect any risk factors of developing postoperative complications.Significant factors were further analyzed for between-group difference of the CCI value and the CDC grade using ?2 test.Spearman's rank test was performed to compare the correlation of each complication scale with postoperative LOS and medical cost.Correlation coefficients were calculated for comparison and scatterplots were drawn.Univariate analysis was performed to compare difference of prolonged LOS in various factors.Significant factors were assembled for binary logistic regression model with each complication system.Cumulative sum control(CUSUM)models were applied to monitor the surgical quality of surgeons continuously.Results:Totally,297 complications occurred in 144(33.8%)patients.The rate of severe complications(CDC grade ? ?)was 12.9%and the mean CCI was 9.8 ± 15.5.Preoperative glucocorticoids usage and previous abdominal surgery were related to higher CCI value(p = 0.002,p = 0.006,respectively)but not higher incidence of severe complications(CDC grade ? ?)(p = 0.117,p = 0.177,respectively).In patients with multiple complications,the CCI demonstrated a stronger correlation with hospital stay(p=0.604,p<0.001)than CDC(p=0.508,p<0.001).Higher CCI value(p<0.001,OR 1.161,95%CI 1.093-1.234)and the CDC grade(p<0.001,OR 3.811,95%CI 2.283-6.362)were risk factors for prolonged LOS.Receiver operating characteristic curve analysis demonstrated that the CCI value is predictive of prolonged postoperative length of stay.The optimal cutoff value was 24.2(95%CI 0.925 to 0.970,p<0.001).The sensitivity was 94.1%and the specificity was 85.0%,respectively In the CUSUM-CCI model of IBD surgery,a gradual decrease was observed over time,and the incidence of postoperative complications of the surgeon was gradually reduced and fluctuated at a certain level.Conclusions:Postoperative complication is risk factors for prolonged postoperative length of stay(LOS)after surgery for IBD patients.The CCI is more sensitive than CDC in evaluating the postoperative complications in IBD.The CCI value is predictive of prolonged postoperative length of stay.The CUSUM-CCI model is effective in continuously monitoring surgical quality. |
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