Postoperative Complications After Cytoreductive Surgery for Advanced Ovarian Carcinoma: A Single-Center Analysis Exploring the Value of the Comprehensive Complication Index and the Predictors of High Complications Burden
Abstract
Background
The comprehensive complication index (CCI) reflects the overall patient complication burden on a 0–100 scale. This single-institution retrospective analysis explores the accuracy of CCI in describing complications following cytoreductive surgery for advanced high-grade ovarian carcinoma (HGOC) and aims to identify predictive factors of high complication burden.
Patients and Methods
In total, 304 patients who underwent cytoreductive surgery for FIGO stage IIIA–IVB HGOC at our institution from 2015 to 2023 were analyzed. Each complication’s severity was graded using the Clavien–Dindo classification. The CCI was used to quantify the global complications burden, and patients were stratified into three groups: CCI-low (< 26.2), CCI-intermediate (26 ≤ CCI < 33.7), and CCI-high (≥ 33.7).
Results
Of the 200 patients (65.8%) with at least one complication, 127 (41.8%) were CCI-low, 32 (10.5%) CCI-intermediate, and 41 (13.5%) CCI-high. Median hospitalization duration (p < 0.0001) and readmission rates (p < 0.0001) correlated with CCI categories, reflecting increased CCI scores with greater surgical complexity, as assessed by the Aletti surgical complexity score (SCS). Univariate analysis showed a significant association between CCI-high and FIGO stage, surgical complexity, diaphragmatic procedures, multiple bowel resections, length of surgery and intraoperative blood loss. Multivariate analysis confirmed FIGO stage (odds ratio [OR] 2.57), multiple bowel resections (OR 5.61), and blood loss (OR 1.93) as independent risk factors for high complication burden.
Conclusions
The CCI is a good descriptor of postoperative complications in patients undergoing cytoreductive surgery for advanced HGOC by integrating both the severity and number of complications into a single, easily usable, and intuitive quantitative score. FIGO stage, multiple bowel resections, and blood loss—but not surgical timing—are independent predictors of a high complication burden.