Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Design
2.2. Data Collection and Outcome Measures
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data availability statement
Conflicts of Interest
References
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Overall (N = 770) | Complicated (N = 207) | Multi-Complicated (N = 157) | |
---|---|---|---|
Age (median, IQR) | 73 (64–79) | 76 (67–81) | 76 (67–81) |
Sex (n, %) | |||
Male | 389 (50.5) | 121 (58.5) | 90 (57.3) |
Female | 381 (49.5) | 86 (41.5) | 67 (42.7) |
Charlson Comorbidity Index (median, IQR) | 6 (4–7) | 6 (5–8) | 6 (5–8) |
Preoperative Hemoglobin (g/dL; median, IQR) | 11.9 (10.3–13.6) | 11.5 (10.1–13.3) | 11.4 (10.1–13.1) |
ASA score (n, %) | |||
1 | 45 (5.8) | 6 (2.9) | 5 (3.2) |
2 | 420 (54.5) | 83 (40.1) | 66 (42.0) |
3 | 282 (36.6) | 107 (51.7) | 81 (51.6) |
4 | 23 (3.1) | 11 (5.3) | 5 (3.2) |
Surgical procedure (n, %) | |||
Left colectomy | 264 (34.3) | 70 (33.8) | 52 (33.1) |
Right colectomy | 506 (65.7) | 137 (66.2) | 105 (66.9) |
Operative time (minutes; median, IQR) | 172 (140–215) | 175 (135–222.5) | 165 (135–220) |
Laparoscopy (n, %) | 378 (49.1) | 91 (44.0) | 69 (43.9) |
Stage (n, %) | |||
I–II | 460 (59.7) | 112 (54.1) | 89 (56.7) |
III | 251 (32.6) | 78 (37.7) | 54 (34.4) |
IV | 59 (7.7) | 17 (8.2) | 14 (8.9) |
Overall (N = 770) | Complicated (N = 207) | Multi-Complicated (N = 157) | |
---|---|---|---|
Type of complication (n, %) | |||
Anastomotic leakage | 27 (3.5) | 27 (13.0) | 27 (17.2) |
Surgical site infection | 44 (5.7) | 44 (21.3) | 35 (22.3) |
Intraperitoneal abscess | 13 (1.7) | 13 (6.3) | 13 (8.3) |
Respiratory complication | 29 (3.8) | 29 (14.0) | 26 (16.6) |
Cardiovascular complication | 27 (3.5) | 27 (13.0) | 18 (11.5) |
Urinary tract infection | 14 (1.8) | 14 (6.8) | 8 (5.1) |
Neurological complication | 12 (1.6) | 12 (5.8) | 4 (2.5) |
Perioperative transfusion | 66 (8.6) | 66 (31.9) | 60 (38.2) |
Others | 46 (6.0) | 46 (22.2) | 37 (23.6) |
Postoperative LOS (days; median, IQR) | 8 (7–11) | 12 (9–18) | 13 (9–21) |
Prolonged LOS (n, %) | 167 (21.7) | 131 (63.3) | 111 (70.7) |
CDC (n, %) | |||
0 | 563 (73.1) | - | - |
1 | 53 (6.9) | 53 (25.6) | 20 (12.7) |
2 | 97 (12.6) | 97 (46.9) | 80 (51.0) |
3a | 9 (1.2) | 9 (4.3) | 9 (5.7) |
3b | 35 (4.5) | 35 (16.9) | 35 (22.3) |
4a | 11 (1.4) | 11 (5.3) | 11 (7.0) |
4b | 2 (0.3) | 2 (1.0) | 2 (1.3) |
CCI (median, IQR) | 0 (0–8.7) | 20.9 (20.9–36.2) | 29.6 (20.9–40.6) |
30 days readmission (n, %) | 37 (4.8) | 19 (9.2) | 18 (11.5) |
OVERALL | COMPLICATED | MULTI-COMPLICATED | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
LOS | CCI | CDC | CCI | CDC | CCI | CDC | ||||||||||||
Analysis | Median LOS Change per 10 Units Increment (95% CI) | Model Goodness of Fit | Median LOS Change per Category Increment (95% CI) | Model goodness of fit | Median LOS Change per 10 Units Increment (95% CI) | Model goodness of fit | Median LOS Change per Category Increment (95% CI) | Model Goodness of Fit | Median LOS Change per 10 Units Increment (95% CI) | Model Goodness of Fit | Median LOS Change per Category Increment (95% CI) | Model Goodness of Fit | ||||||
Univariate | 2.392 (1.909–2.648) | 0.186 | 2.750 (1.435–3.858) | 0.160 | 4.068 (3.178–5.000) | 0.245 | 4.667 (2.964–5.846) | 0.179 | 5.960 (4.284–6.665) | 0.312 | 5.0 (3.214–7.680) | 0.168 | ||||||
Multivariate | 2.448 (2.038–2.723) | 0.169 | 2.715 (2.306–3.207) | 0.149 | 3.997 (3.059–5.124) | 0.219 | 3.985 (3.335–5.287) | 0.162 | 6.064 (4.550–6.594) | 0.299 | 4.904 (3.526–6.315) | 0.166 | ||||||
Prolonged LOS | CCI | CDC | CCI | CDC | CCI | CDC | ||||||||||||
Analysis | OR per 10 Units Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per Category Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per 10 Units Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per Category Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per 10 Units Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per Category Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC |
Univariate | 2.513 (2.150–2.937) | 0.988 | 0.771 | 2.954 (2.457–3.551) | 1 | 0.766 | 2.047 (1.547–2.709) | 0.605 | 0.752 | 2.284 (1.627–3.206) | 1 | 0.700 | 2.044 (1.388–3.011) | 0.861 | 0.736 | 1.824 (1.277–2.605) | 0.994 | 0.646 |
Multivariate | 2.418 (2.040–2.867) | 0.064 | 0.837 | 2.795 (2.289–3.412) | 0.215 | 0.830 | 1.936 (1.431–2.619) | 0.952 | 0.801 | 2.056 (1.432–2.953) | 0.934 | 0.782 | 1.920 (1.277–2.889) | 0.397 | 0.797 | 1.725 (1.172–2.539) | 0.603 | 0.772 |
Readmission | CCI | CDC | CCI | CDC | CCI | CDC | ||||||||||||
Analysis | OR per 10 Units Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per Category Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per 10 Units Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per Category Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per 10 Units Increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC | OR per category increment (95% CI) | Hosmer-Lemeshow Test p-Value | AUC |
Univariate | 1.456 (1.255–1.688) | 1 | 0.657 | 1.507 (1.241–1.830) | 1 | 0.648 | 1.522 (1.184–1.957) | 0.181 | 0.720 | 1.444 (1.021–2.044) | 0.925 | 0.651 | 1.444 (1.088–1.916) | 0.382 | 0.673 | 1.291 (0.884–1.886) | 0.958 | 0.604 |
Multivariate | 1.482 (1.258–1.745) | 0.606 | 0.691 | 1.524 (1.232–1.886) | 0.498 | 0.693 | 1.808 (1.321–2.475) | 0.727 | 0.828 | 1.601 (1.075–2.384) | 0.404 | 0.785 | 1.743 (1.232–2.465) | 0.701 | 0.806 | 1.426 (0.930–2.188) | 0.949 | 0.746 |
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Tamini, N.; Bernasconi, D.; Ripamonti, L.; Lo Bianco, G.; Braga, M.; Nespoli, L. Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery. Cancers 2021, 13, 1745. https://doi.org/10.3390/cancers13071745
Tamini N, Bernasconi D, Ripamonti L, Lo Bianco G, Braga M, Nespoli L. Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery. Cancers. 2021; 13(7):1745. https://doi.org/10.3390/cancers13071745
Chicago/Turabian StyleTamini, Nicolò, Davide Bernasconi, Lorenzo Ripamonti, Giulia Lo Bianco, Marco Braga, and Luca Nespoli. 2021. "Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery" Cancers 13, no. 7: 1745. https://doi.org/10.3390/cancers13071745
APA StyleTamini, N., Bernasconi, D., Ripamonti, L., Lo Bianco, G., Braga, M., & Nespoli, L. (2021). Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery. Cancers, 13(7), 1745. https://doi.org/10.3390/cancers13071745