The comprehensive complication index (CCI1) is a novel cost assessment tool for surgical procedures

Roxane D. Staiger, Matteo Cimino, Ammar Javed, Sebastiano Biondo, Constantino Fondevila, Julie Périnel, Ana Carolina Aragão, Guido Torzilli, Christopher Wolfgang, Mustapha Adham, Hugo Pinto-Marques, Philipp Dutkowski, Milo A. Puhan, Pierre Alain Clavien

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


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 (CCI1), 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 ¼ 1388). CCI1 was used to quantify overall postoperative morbidity. Pearson correlation coefficient (rpears) was calculated for cost and CCI1. For cost prediction, a linear regression model based on CCI1, age, and type of surgery was developed and validated in an international cohort of patients. Results: We found a high correlation between CCI1 and overall cost (rpears ¼ 0.75) with the strongest correlation for more complex procedures. The prediction model performed very well (R2 ¼ 0.82); each 10-point increase in CCI1 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 CCI1 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 (

Original languageEnglish (US)
Pages (from-to)784-791
Number of pages8
JournalAnnals of surgery
Issue number5
StatePublished - 2018


  • CCI
  • Complications
  • Cost
  • Morbidity
  • Surgery

ASJC Scopus subject areas

  • Surgery


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