The Comprehensive Complication Index (CCI®) is a Novel Cost Assessment Tool for Surgical Procedures

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

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