Comparison of Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) systems for grading of surgical complications in patients with gastroduodenal perforations-a prospective study.

Abstract

Objective: Gastro-duodenal perforation is a life-threatening surgical emergency associated with high morbidity and mortality, particularly in low- and middle-income countries due to delayed presentation and sepsis. Accurate assessment of postoperative complications is essential for predicting outcomes. While the Clavien-Dindo classification (CDC) is widely used, it records only the highest-grade complication, potentially underestimating overall morbidity. The comprehensive complication index (CCI), a continuous scale incorporating all complications, may provide better prognostic value.

Material and methods: This prospective observational study was conducted over 18 months in a tertiary care centre in northern India and included 50 adult patients with gastro-duodenal perforation. Postoperative complications were graded using CDC and quantified using CCI. Associations with length of hospital stay (LOS) were analysed using ANOVA, Pearson's correlation, and multivariate linear regression.

Results: The mean age was 42.26±12.92 years, with a predominance of male and rural patients. Most participants had CDC Grade 3A complications (72%), with a mean CCI of 32.94±14.82. LOS increased significantly with higher CDC grades and CCI categories (p<0.01). CCI showed a significant moderate correlation with LOS (r=0.444, p=0.001), whereas CDC demonstrated a weak, non-significant correlation (r=0.149, p=0.303). On multivariate analysis, CCI independently predicted LOS (β=0.17, p<0.001), while CDC was not significant. The CCI-based model showed better predictive performance (R²=0.35) compared to the CDC model (R²=0.21).

Conclusion: The CCI is a superior predictor of postoperative morbidity and hospital stay compared to CDC, particularly in patients with lower-grade CDC complications, as it more comprehensively reflects the cumulative burden of complications.