Langenbeck's Archives of Surgery

, Volume 403, Issue 8, pp 1021–1027 | Cite as

Development and validation of a new score for measuring post-operative complications

  • Rajesh PanwarEmail author
  • Vedavyas Mohapatra
  • Karthik Raichurkar
  • Peush Sahni



Assigning a numerical value to post-operative morbidity may improve its usefulness as an outcome measure. The recently developed Comprehensive Complication Index (CCI) is a step forward in this process but assigns an inappropriately high score to a combination of complications.


We developed a new score called the complication severity score (CSS) using a mathematical process and compared it with the CCI using a questionnaire-based survey of 49 experienced gastrointestinal and hepato-pancreatico-biliary surgeons. The CSS was modified based on the results of this survey and was correlated with other patient-centered outcomes in a prospective cohort of consecutive patients undergoing elective surgery.


Of the nine sets of scenarios, experienced surgeons’ opinion matched with CSS in 6, CSS as well as CCI in 1, and neither CSS nor CCI in 2 scenarios. Of the total 441 responses, 281 matched with CSS while 143 matched with CCI (p = 0.0001, odds ratio: 3.7; 95% CI: 2.8 to 4.8). The modified CSS significantly correlated with the post-operative length of stay (r = 0.76; 95% CI: 0.68 to 0.82; p < 0.001), the length of ICU stay (r = 0.61; 95% CI: 0.50 to 0.70; p < 0.001) and with the difference between pre-operative and post-operative quality of life scores in the physical (r = 0.29; 95% CI: 0.14 to 0.42; p < 0.001) and social (r = 0.29; 95% CI: 0.14 to 0.43; p < 0.001) domains.


The CSS more often matched the opinion of experienced senior surgeons compared to CCI. The modified CSS significantly correlated with other patient-centered outcomes.


Morbidity Clavien–Dindo Comprehensive complication index Complication severity score Post-operative complications 


Authors’ contributions

RP: conceptualization, study planning, data collection & compilation, manuscript preparation, statistical analysis. VM: data collection & compilation. KR: data collection & compilation. PS: study planning, data collection, editing of manuscript. All authors were involved in the drafting of the work and revising it critically for important intellectual content and have approved the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with ethical standards


The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Conflicts of interest

Authors RP, VM, KR & PS have no conflicts of interest to declare.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

423_2018_1701_MOESM1_ESM.docx (110 kb)
ESM 1 (DOCX 110 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastrointestinal Surgery & Liver TransplantationAll India Institute of Medical SciencesNew DelhiIndia

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