The Comprehensive Complication Index (CCI®) is a Novel Cost Assessment Tool for Surgical Procedures

<jats:sec> <jats:title>Objective:</jats:title> <jats:p>The aim of this study was to identify a readily available, reproducible, and internationally applicable cost assessment tool for surgical procedures.</jats:p> </jats:sec> <jats:sec> <jats:title>Summary of Background Data:</jats:title> <jats:p>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 (CCI<jats:sup>®</jats:sup>), reflecting overall postoperative morbidity, may therefore serve as a new marker for cost.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>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 = 1388). CCI<jats:sup>®</jats:sup> was used to quantify overall postoperative morbidity. Pearson correlation coefficient (<jats:italic toggle="yes">r</jats:italic> <jats:sub>pears</jats:sub>) was calculated for cost and CCI<jats:sup>®</jats:sup>. For cost prediction, a linear regression model based on CCI<jats:sup>®</jats:sup>, age, and type of surgery was developed and validated in an international cohort of patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>We found a high correlation between CCI<jats:sup>®</jats:sup> and overall cost (<jats:italic toggle="yes">r</jats:italic> <jats:sub>pears</jats:sub> = 0.75) with the strongest correlation for more complex procedures. The prediction model performed very well (<jats:italic toggle="yes">R</jats:italic> <jats:sup>2</jats:sup> = 0.82); each 10-point increase in CCI<jats:sup>®</jats:sup> 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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>Overall postoperative morbidity correlates highly with cost. The CCI<jats:sup>®</jats:sup> 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 ( <jats:italic toggle="yes">www.assessurgery.com</jats:italic> ).</jats:p> </jats:sec>