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The economic burden of postoperative complications measured by the Comprehensive Complication Index® occurring in patients undergoing elective major hepatopancreaticobiliary surgery in a London tertiary referral hospital – A prospective health economics study

  • Postoperative complications have a tremendous impact on in-hospital costs per case and complications. 
  • The novel Comprehensive Complication Index® (CCI®) summarizes all postoperative complications and is more sensitive than existing morbidity endpoints.
  • The purpose of this study is to:
    • Assess the correlation of CCI® with in-hospital costs.
    • Establish the cost per unit of CCI for each different procedure. 
    • Assess the economic burden they represent.
  • This will be a prospective study including all consecutive patients undergoing elective major hepatopancreaticobiliary surgery at the Royal Free Hospital in London.
  • Data collection will include:
    • Patient demographics
    • Comorbidities
    • Disease and operation characteristics
    • Postoperative morbidity
    •  Intensive care unit and hospital stay
    • Mortality.
  • The total costs per patient will be obtained from the finance department of the hospital.
  • Fully anonymised data will be collected without any patient identifiers.
  • In the pilot phase of this study, a sample size calculation using the standard bivariate model, with a two-sided alpha of 0.05 and power of 0.80, will be conducted after having included 30 cases to estimate the correlation coefficient of the CCI® with the total in-hospital costs.
  • Univariate analysis will include correlation of the CCI® with costs, overall and the subgroups of the different procedures (complex biliary, minor and major liver surgery, pancreatic surgery).
  • The CCI® as well as the absolute in-hospital costs will be compared among the different types of procedures with non-parametric tests.
  • Multivariate linear regression analysis will be performed using a multivariate linear regression model adjusted for potential confounders.  
  • This study will highlight a relevant savings capacity for major surgical procedures and supports all efforts to lower negative events in the postoperative course. 

Click here to access the protocol.