Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma
Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian...
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-12-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/12/12/3868 |
| _version_ | 1797543924359757824 |
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| author | Alessandro Giani Federica Cipriani Simone Famularo Matteo Donadon Davide Paolo Bernasconi Francesco Ardito Federico Fazio Daniele Nicolini Pasquale Perri Mario Giuffrida Nicholas Pontarolo Matteo Zanello Quirino Lai Simone Conci Sarah Molfino Paola Germani Enrico Pinotti Maurizio Romano Giuliano La Barba Cecilia Ferrari Stefan Patauner Alberto Manzoni Ivano Sciannamea Luca Fumagalli Albert Troci Valentina Ferraro Antonio Floridi Fabrizio Romano Cristina Ciulli Marco Braga Francesca Ratti Guido Costa Francesco Razionale Nadia Russolillo Laura Marinelli Valerio De Peppo Elena Cremaschi Francesco Calabrese Zoe Larghi Laureiro Giovanni Lazzari Davide Cosola Mauro Montuori Luca Salvador Alessandro Cucchetti Angelo Franceschi Michele Ciola Valentina Sega Pietro Calcagno Luca Pennacchi Michele Tedeschi Riccardo Memeo Michele Crespi Marco Chiarelli Adelmo Antonucci Giuseppe Zimmitti Antonio Frena Andrea Percivale Giorgio Ercolani Giacomo Zanus Mauro Zago Paola Tarchi Gian Luca Baiocchi Andrea Ruzzenente Massimo Rossi Elio Jovine Marcello Maestri Raffaele Dalla Valle Gian Luca Grazi Marco Vivarelli Alessandro Ferrero Felice Giuliante Guido Torzilli Luca Aldrighetti Luca Gianotti |
| author_facet | Alessandro Giani Federica Cipriani Simone Famularo Matteo Donadon Davide Paolo Bernasconi Francesco Ardito Federico Fazio Daniele Nicolini Pasquale Perri Mario Giuffrida Nicholas Pontarolo Matteo Zanello Quirino Lai Simone Conci Sarah Molfino Paola Germani Enrico Pinotti Maurizio Romano Giuliano La Barba Cecilia Ferrari Stefan Patauner Alberto Manzoni Ivano Sciannamea Luca Fumagalli Albert Troci Valentina Ferraro Antonio Floridi Fabrizio Romano Cristina Ciulli Marco Braga Francesca Ratti Guido Costa Francesco Razionale Nadia Russolillo Laura Marinelli Valerio De Peppo Elena Cremaschi Francesco Calabrese Zoe Larghi Laureiro Giovanni Lazzari Davide Cosola Mauro Montuori Luca Salvador Alessandro Cucchetti Angelo Franceschi Michele Ciola Valentina Sega Pietro Calcagno Luca Pennacchi Michele Tedeschi Riccardo Memeo Michele Crespi Marco Chiarelli Adelmo Antonucci Giuseppe Zimmitti Antonio Frena Andrea Percivale Giorgio Ercolani Giacomo Zanus Mauro Zago Paola Tarchi Gian Luca Baiocchi Andrea Ruzzenente Massimo Rossi Elio Jovine Marcello Maestri Raffaele Dalla Valle Gian Luca Grazi Marco Vivarelli Alessandro Ferrero Felice Giuliante Guido Torzilli Luca Aldrighetti Luca Gianotti |
| author_sort | Alessandro Giani |
| collection | DOAJ |
| description | Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale. |
| first_indexed | 2024-03-10T13:53:03Z |
| format | Article |
| id | doaj.art-80447168521e4100b6324dd0b220231e |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T13:53:03Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-80447168521e4100b6324dd0b220231e2023-11-21T01:56:11ZengMDPI AGCancers2072-66942020-12-011212386810.3390/cancers12123868Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular CarcinomaAlessandro Giani0Federica Cipriani1Simone Famularo2Matteo Donadon3Davide Paolo Bernasconi4Francesco Ardito5Federico Fazio6Daniele Nicolini7Pasquale Perri8Mario Giuffrida9Nicholas Pontarolo10Matteo Zanello11Quirino Lai12Simone Conci13Sarah Molfino14Paola Germani15Enrico Pinotti16Maurizio Romano17Giuliano La Barba18Cecilia Ferrari19Stefan Patauner20Alberto Manzoni21Ivano Sciannamea22Luca Fumagalli23Albert Troci24Valentina Ferraro25Antonio Floridi26Fabrizio Romano27Cristina Ciulli28Marco Braga29Francesca Ratti30Guido Costa31Francesco Razionale32Nadia Russolillo33Laura Marinelli34Valerio De Peppo35Elena Cremaschi36Francesco Calabrese37Zoe Larghi Laureiro38Giovanni Lazzari39Davide Cosola40Mauro Montuori41Luca Salvador42Alessandro Cucchetti43Angelo Franceschi44Michele Ciola45Valentina Sega46Pietro Calcagno47Luca Pennacchi48Michele Tedeschi49Riccardo Memeo50Michele Crespi51Marco Chiarelli52Adelmo Antonucci53Giuseppe Zimmitti54Antonio Frena55Andrea Percivale56Giorgio Ercolani57Giacomo Zanus58Mauro Zago59Paola Tarchi60Gian Luca Baiocchi61Andrea Ruzzenente62Massimo Rossi63Elio Jovine64Marcello Maestri65Raffaele Dalla Valle66Gian Luca Grazi67Marco Vivarelli68Alessandro Ferrero69Felice Giuliante70Guido Torzilli71Luca Aldrighetti72Luca Gianotti73School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, ItalyHepatobiliary Surgery Division, Ospedale San Raffaele, 20132 Milan, ItalySchool of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, ItalyDepartment of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, ItalyBicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, ItalyHepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00118 Rome, ItalyDepartment of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, 10112 Turin, ItalyHepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, ItalyDivision of Hepatobiliarypancreatic surgery, IRCCS—Regina Elena National Cancer Institute, 00119 Rome, ItalyDepartment of Medicine and Surgery, University of Parma, 43126 Parma, ItalyUnit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, 27100 Pavia, ItalyDepartment of Surgery, AOU Sant’Orsola Malpighi, IRCCS Azienda Ospedaliera Universitaria, 40141 Bologna, ItalyHepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, 00118 Rome, ItalyDivision of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, ItalyDepartment of General Surgery, ASUGI, University Hospital of Trieste, 34121 Trieste, ItalyDepartment of Surgery, Ponte San Pietro Hospital, 24129 Bergamo, ItalyDepartment of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua; Hepatobiliary and Pancreatic Surgery Unit—Treviso Hospital, 31102 Treviso ItalyGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, 47122 Forlì, ItalyHPB Surgical Unit, San Paolo Hospital, 17100 Savona, ItalyDepartment of Surgery, Bolzano Central Hospital, 39100 Bolzano, ItalyDepartment of General Surgery, Poliambulanza Foundation Hospital, 25136 Brescia, ItalyDepartment of Surgery, Monza Polyclinic, 20900 Monza, ItalyDepartment of Emergency and Robotic Surgery, ASST Lecco, 23900 Lecco, ItalyDepartment of Surgery, L. Sacco Hospital, 20143 Milan, ItalyDepartment of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, 70132 Bari, ItalyDepartment of General Surgery, ASST Crema, 26013 Crema, ItalySchool of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, ItalySchool of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, ItalySchool of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, ItalyHepatobiliary Surgery Division, Ospedale San Raffaele, 20132 Milan, ItalyDepartment of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, ItalyHepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00118 Rome, ItalyDepartment of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, 10112 Turin, ItalyHepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, ItalyDivision of Hepatobiliarypancreatic surgery, IRCCS—Regina Elena National Cancer Institute, 00119 Rome, ItalyDepartment of Medicine and Surgery, University of Parma, 43126 Parma, ItalyUnit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, 27100 Pavia, ItalyHepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, 00118 Rome, ItalyDivision of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, ItalyDepartment of General Surgery, ASUGI, University Hospital of Trieste, 34121 Trieste, ItalyDepartment of Surgery, Ponte San Pietro Hospital, 24129 Bergamo, ItalyDepartment of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua; Hepatobiliary and Pancreatic Surgery Unit—Treviso Hospital, 31102 Treviso ItalyGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, 47122 Forlì, ItalyHPB Surgical Unit, San Paolo Hospital, 17100 Savona, ItalyDepartment of Surgery, Bolzano Central Hospital, 39100 Bolzano, ItalyDepartment of General Surgery, Poliambulanza Foundation Hospital, 25136 Brescia, ItalyDepartment of Emergency and Robotic Surgery, ASST Lecco, 23900 Lecco, ItalyDepartment of Surgery, L. Sacco Hospital, 20143 Milan, ItalyDepartment of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, 70132 Bari, ItalyDepartment of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, 70132 Bari, ItalyDepartment of Surgery, L. Sacco Hospital, 20143 Milan, ItalyDepartment of Emergency and Robotic Surgery, ASST Lecco, 23900 Lecco, ItalyDepartment of Surgery, Monza Polyclinic, 20900 Monza, ItalyDepartment of General Surgery, Poliambulanza Foundation Hospital, 25136 Brescia, ItalyDepartment of Surgery, Bolzano Central Hospital, 39100 Bolzano, ItalyHPB Surgical Unit, San Paolo Hospital, 17100 Savona, ItalyGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, 47122 Forlì, ItalyDepartment of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua; Hepatobiliary and Pancreatic Surgery Unit—Treviso Hospital, 31102 Treviso ItalyDepartment of Surgery, Ponte San Pietro Hospital, 24129 Bergamo, ItalyDepartment of General Surgery, ASUGI, University Hospital of Trieste, 34121 Trieste, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, ItalyDivision of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, ItalyHepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, 00118 Rome, ItalyDepartment of Surgery, AOU Sant’Orsola Malpighi, IRCCS Azienda Ospedaliera Universitaria, 40141 Bologna, ItalyUnit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, 27100 Pavia, ItalyDepartment of Medicine and Surgery, University of Parma, 43126 Parma, ItalyDivision of Hepatobiliarypancreatic surgery, IRCCS—Regina Elena National Cancer Institute, 00119 Rome, ItalyHepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, ItalyDepartment of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, 10112 Turin, ItalyHepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00118 Rome, ItalyDepartment of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, ItalyHepatobiliary Surgery Division, Ospedale San Raffaele, 20132 Milan, ItalySchool of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, ItalyBackground: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.https://www.mdpi.com/2072-6694/12/12/3868liver surgeryhepatocellular carcinomaClavien-Dindo classificationcomprehensive complication indexperformancelength of stay |
| spellingShingle | Alessandro Giani Federica Cipriani Simone Famularo Matteo Donadon Davide Paolo Bernasconi Francesco Ardito Federico Fazio Daniele Nicolini Pasquale Perri Mario Giuffrida Nicholas Pontarolo Matteo Zanello Quirino Lai Simone Conci Sarah Molfino Paola Germani Enrico Pinotti Maurizio Romano Giuliano La Barba Cecilia Ferrari Stefan Patauner Alberto Manzoni Ivano Sciannamea Luca Fumagalli Albert Troci Valentina Ferraro Antonio Floridi Fabrizio Romano Cristina Ciulli Marco Braga Francesca Ratti Guido Costa Francesco Razionale Nadia Russolillo Laura Marinelli Valerio De Peppo Elena Cremaschi Francesco Calabrese Zoe Larghi Laureiro Giovanni Lazzari Davide Cosola Mauro Montuori Luca Salvador Alessandro Cucchetti Angelo Franceschi Michele Ciola Valentina Sega Pietro Calcagno Luca Pennacchi Michele Tedeschi Riccardo Memeo Michele Crespi Marco Chiarelli Adelmo Antonucci Giuseppe Zimmitti Antonio Frena Andrea Percivale Giorgio Ercolani Giacomo Zanus Mauro Zago Paola Tarchi Gian Luca Baiocchi Andrea Ruzzenente Massimo Rossi Elio Jovine Marcello Maestri Raffaele Dalla Valle Gian Luca Grazi Marco Vivarelli Alessandro Ferrero Felice Giuliante Guido Torzilli Luca Aldrighetti Luca Gianotti Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma Cancers liver surgery hepatocellular carcinoma Clavien-Dindo classification comprehensive complication index performance length of stay |
| title | Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma |
| title_full | Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma |
| title_fullStr | Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma |
| title_full_unstemmed | Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma |
| title_short | Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma |
| title_sort | performance of comprehensive complication index and clavien dindo complication scoring system in liver surgery for hepatocellular carcinoma |
| topic | liver surgery hepatocellular carcinoma Clavien-Dindo classification comprehensive complication index performance length of stay |
| url | https://www.mdpi.com/2072-6694/12/12/3868 |
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