Postoperative complications in gastrointestinal surgery: A “hidden” basic quality indicator

Table 1 Comparison of the characteristics of the clavien dindo classification, the comprehensive complication index and the complication severity score

	CDC	CCI	CSS
Year of publication	2004	2013	2018
Criteria used	Opinions of 144 surgeons	Opinions of 227 patients and 245 physicians (surgeons, anesthetists and intensivists)	Opinions of 49 gastrointestinal and hepato-pancreatico-biliary surgeons in India
Scale and calculation	Classifies the complications in 5 grades. The therapy used to correct a specific complication remains the cornerstone to rank a complication.	All the complications must be classified according to the CDC, and the score is then calculated with the formula or on-line.	All the complications must be classified according to the CDC, and the score is then calculated with the formula.
Value	Considers only the most severe complication: 0-V	Considers all the complications: 0-100. Higher numerical value than the CSS.	Considers all the complications: 0-100. Lower numerical value than the CCI
Validation with clinical results	Yes	Yes	Yes (PhD thesis)[17]
Bibliographical citings	10635	224	2
Management	More straightforward	More complex in patients with multiple complications	More complex in patients with multiple complications
Does it adequately represent the postoperative course of patients with ≥ 2 complications?	No	Yes	Yes
Does it all comparison of the results?	No, if there are ≥ 2 complications	Yes	Yes

CDC: Clavien Dindo Classification; CSS: Complication Severity Score; CCI: Comprehensive Complication Index.