Background/Objectives: The Clavien–Dindo classification (CDC) grades the most severe post-operative complication and may not comprehensively reflect cumulative surgical morbidity. Our objective was to investigate the potential incremental role of the comprehensive complication index (CCI) over the CDC in defining the quality of robot-assisted radical cystectomy (RARC).Methods: Data were extracted from the Asian RARC Consortium database. Complications were classified using the CCI (CCI = 0, CCI < 75th and ≥75th percentile) and CDC. Adverse peri-operative outcomes such as length of stay >14 days (LOS > 14 days), estimated blood loss >350 mL (EBL > 350 mL), time to solid food intake >4 days (TFI > 4 days) and 30-day readmission rates were analyzed. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves for CCI and CDC were compared for the various adverse outcomes.Results: The peri-operative complication rate was 44.4%, comprising 11.6% with severe complications (CDC ≥ III). The mean CCI was 10.2 (±13.5) while median CCI was 0 (IQR 0–21). There were 7.6% of patients with >one perioperative complication. On adjusted analysis, CCI ≥ 75th percentile was significantly associated with greater LOS (>14 days) (OR 2.21, 95% CI 1.47–3.31,p< 0.001) compared to when CCI = 0. There were no significant differences in the AUC between CDC and CCI in predicting LOS > 14 days, TFI > 4 days, 30-day readmission or EBL > 350 mL.Conclusions: In our multi-institutional cohort, the CCI did not provide additional discrimination over CDC, and this is likely related to the limited number of complications that occurred per individual in the Asian RARC cohort. Hence, the perceived advantages of CCI over CDC are contextual.
背景/目的：Clavien-Dindo分级系统（CDC）仅对最严重的术后并发症进行分级，可能无法全面反映累积的手术并发症负担。本研究旨在探讨综合并发症指数（CCI）相较于CDC在评估机器人辅助根治性膀胱切除术（RARC）手术质量方面的潜在增量价值。 方法：数据来源于亚洲RARC联盟数据库。并发症分别采用CCI（分为CCI=0、CCI<75百分位数及CCI≥75百分位数）和CDC两种系统进行分类。分析的不良围手术期结局包括：住院时间>14天、估计失血量>350 mL、固体食物摄入时间>4天以及30天再入院率。通过比较CCI与CDC预测各不良结局的受试者工作特征曲线下面积（AUC）进行评估。 结果：围手术期并发症发生率为44.4%，其中严重并发症（CDC≥III级）占11.6%。CCI平均值为10.2（±13.5），中位数为0（四分位距0-21）。7.6%的患者发生不止一种围手术期并发症。校正分析显示，与CCI=0的患者相比，CCI≥75百分位数的患者住院时间>14天的风险显著更高（OR 2.21，95% CI 1.47-3.31，p<0.001）。在预测住院时间>14天、固体食物摄入>4天、30天再入院或失血量>350 mL方面，CDC与CCI的AUC无显著差异。 结论：在本多中心研究队列中，CCI并未表现出优于CDC的鉴别能力，这可能与亚洲RARC队列中个体并发症发生数量有限有关。因此，CCI相对于CDC的优势具有情境依赖性。
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