The Comprehensive Complication Index: a New Measure of the Burden of Complications After Hyperthermic Intraperitoneal Chemotherapy

Ann Surg Oncol. 2018 Mar;25(3):688-693. doi: 10.1245/s10434-017-6157-z. Epub 2017 Dec 19.


Background: Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) are complex surgeries with multiple comorbidities. The Clavien-Dindo classification (CDC) is the most commonly used method to report surgical morbidity, but limits it to the highest-grade complication. The Comprehensive Complication Index (CCI) is a score ranging from 0 to 100, calculated using all 30-day complications and their treatment after abdominal surgery. The aim of this study is to assess the CCI's validity in the HIPEC patient population.

Methods: A review of our institutional cytoreduction database from 2009 to 2015 was undertaken. Patient demographics, pathology, Peritoneal Carcinomatosis Index (PCI), complications and their treatments, and length of stay (LOS) were reviewed. The CCI was calculated for each patient. Linear regression was used to assess whether the CCI and CDC were predictors of LOS.

Results: Of 157 patients reviewed, 110 (70.1%) underwent HIPEC. The majority were female (77, 66.9%), and the mean age was 53.7 years. Mean PCI was 13.2 [interquartile range (IQR) 7-18]. Median CDC was grade 2 (IQR 0-2), and only 9.8% had CDC of grade 4 or higher. Mean CCI was 21.4, while the median was 20.9 (IQR 0-30.8). Mean LOS was 16.2 days, while the median was 11 days (IQR 8-15 days). The CCI strongly correlated with LOS with coefficient of 0.46 [95% confidence interval (CI) 0.38-0.54, p = 0.000].

Conclusions: The CCI is an adequate tool to capture all complications and their overall burden in patients having undergone HIPEC. This study shows that the CCI can predict LOS and could be used to quantify and compare the burden of multiple complications.

MeSH terms

  • Aged
  • Chemotherapy, Cancer, Regional Perfusion / adverse effects*
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Length of Stay
  • Male
  • Middle Aged
  • Morbidity
  • Peritoneal Neoplasms / pathology*
  • Peritoneal Neoplasms / therapy*
  • Postoperative Complications / etiology*
  • Prognosis
  • Severity of Illness Index*