The Economic Burden of Postoperative Complications Predicted by the Comprehensive Complication Index? in Patients Undergoing Elective Major Hepatopancreaticobiliary Surgery for Malignancy - A Prospective Cost Analysis

Background/Aim: Postoperative complications have a tremendous impact on in-hospital costs. The novel Comprehensive Complication Index (R) (CCI (R)) summarizes all complications together and is more sensitive than existing morbidity endpoints. The purpose of this study was to assess the correlation of CCI (R) with in-hospital costs and externally validate a novel cost prediction calculator. Patients and Methods: This was a prospective study including consecutive patients undergoing elective major hepatopancreaticobiliary (HPB) surgery for malignancy at a London tertiary referral hospital. A priori sample size and post-hoc power calculations were performed. Results: Thirty patients were included in the analysis, 14 were female, and the median age was 67 linterquartile range (IQR)=54-74] years. The median Charlson Comorbidity Index was 6 (IQR=5-8). Eighteen patients underwent liver, 9 pancreatic surgery and three a palliative bypass; 11 patients had a major complication (>= grade 3a) according to the Clavien-Dindo classification. The median CCI (R) was 302 (IQR=12 .18-39 5). The mean cost per case was 13,908 (SD=4,600) GBP. There was no correlation between the Charlson Comorbidity Index or age with actual cost. However, there was very good correlation of actual cost with the CCI (R) (r=0.77, 95% confidence interval=0.57-0.89, p<0.001) as well as with the predicted cost (Clavien Cost Prediction Calculator) (r=0.70, 95% confidence interval=44-0.85, p<0.001). Conclusion: These findings support the hypothesis that complications are the most important predictor of overall cost in the setting of elective major HPB surgery for malignancy. Furthermore, CCI (R) and the novel Cost Prediction Calculator can be used in this setting to accurately predict costs using no additional resources.