Comparison of comprehensive complication index and Clavien-Dindo classification in patients with retroperitoneal sarcoma.

Abstract

Our study aimed to compare the comprehensive complication index (CCI) to the conventional Clavien-Dindo classification (CDC) in patients undergoing surgery for primary retroperitoneal sarcoma (RPS). Data were collected for patients who underwent surgery from 2008 to 2019 at a tertiary institution. The length of hospital stay (LOS) was used as a surrogate marker for clinical outcomes, and associations with CDC and CCI were assessed. Data were available for 191 patients, with the highest CDC Grade of I, II, III, and IV in 18.3%, 41.9%, 17.8%, and 4.2%, respectively; the 30-day postoperative mortality (CDC Grade V) was 1.6% (N = 3). Whilst both classification systems were significantly correlated with LOS, this association was significantly stronger for CCI (Spearman's ρ: 0.768 vs. 0.648, p < 0.001). Increasing Charlson Comorbidity Index, tumor size, and organ weighted resection scores were independently associated with longer LOS. However, the association between LOS and both the CDC and CCI remained significant, even after adjusting for these factors (both p < 0.001). The CCI is more strongly associated with LOS than the CDC, and represents a useful tool to quantify the total burden of postoperative complications after surgery for RPS.