TY - JOUR T1 - The Economic Burden of Postoperative Complications Predicted by the Comprehensive Complication Index<sup>®</sup> in Patients Undergoing Elective Major Hepatopancreaticobiliary Surgery for Malignancy – A Prospective Cost Analysis JF - In Vivo JO - In Vivo SP - 1065 LP - 1071 DO - 10.21873/invivo.12351 VL - 35 IS - 2 AU - DIMITRI ARISTOTLE RAPTIS AU - THOMAS HANNA AU - NIKOLAOS MACHAIRAS AU - TIMOTHY OWEN AU - DANIEL DAVIES AU - GIUSEPPE KITO FUSAI Y1 - 2021/03/01 UR - http://iv.iiarjournals.org/content/35/2/1065.abstract N2 - Background/Aim: Postoperative complications have a tremendous impact on in-hospital costs. The novel Comprehensive Complication Index® (CCI®) summarizes all complications together and is more sensitive than existing morbidity endpoints. The purpose of this study was to assess the correlation of CCI® 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 [interquartile 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® was 30.2 (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=0.77, 95% confidence interval=0.57-0.89, p&lt;0.001) as well as with the predicted cost (Clavien Cost Prediction Calculator) (r=0.70, 95% confidence interval=0.44-0.85, p&lt;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® and the novel Cost Prediction Calculator can be used in this setting to accurately predict costs using no additional resources. ER -