The comprehensive complication index (CCI¹) 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 (CCI¹), 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 ¼ 1388). CCI¹ was used to quantify overall postoperative morbidity. Pearson correlation coefficient (r_pears) was calculated for cost and CCI¹. For cost prediction, a linear regression model based on CCI¹, age, and type of surgery was developed and validated in an international cohort of patients. Results: We found a high correlation between CCI¹ and overall cost (r_pears ¼ 0.75) with the strongest correlation for more complex procedures. The prediction model performed very well (R² ¼ 0.82); each 10-point increase in CCI¹ 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 CCI¹ 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).