Objective
We aimed to validate and evaluate the comprehensive complication index (CCI) as a
measure of postoperative complications (POCs) in the patients with head and neck squamous
cell carcinoma (HNSCC) who had undergone free-flap reconstruction.
Study Design
A single-center, prospective cohort study was conducted on the patients with primary
HNSCC treated between 2015 and 2020.
Results
Of 443 patients, 177 experienced POCs (40.0%). According to the new CCI, 93 patients
had severe POCs (score ≥26.2; 21.0%), and only 76 patients were classified as having
severe POCs (grade ≥III; 17.2%) according to the traditional Clavien-Dindo classification
(CDC). The patients with CCI scores ≥26.2 had a higher rate of major adverse short-term
outcomes, such as prolonged length of the hospital stay after surgery, excessive medical
costs, and the need for transfusion. Importantly, the Kaplan-Meier analysis revealed
a lower overall survival rate for patients with severe complications (CCI score ≥26.2,
P = .038). However, no statistically significant differences were observed between
CDC grades III or above and overall survival (P = .100).
Conclusions
The CCI can be used to evaluate POCs of free-flap reconstruction in patients with
HNSCC. It performed more accurately than the CDC in short- and long-term outcome prediction
and risk factor identification.
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Article info
Publication history
Published online: May 20, 2022
Accepted:
May 13,
2022
Received in revised form:
April 12,
2022
Received:
February 26,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
