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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. A single-center, prospective cohort study was conducted on the patients with primary HNSCC treated between 2015 and 2020. 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). 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. Copyright © 2022 Elsevier Inc. All rights reserved.


Delong Li, Qifang Niu, Chong Wang, Wei Wei, Bo Li, Huan Liu, Ranran Xiao, Hao Wang, Qiaoshi Xu, Zhengxue Han, Zhien Feng. Comprehensive complication index: A new reporting standard for postoperative complications of free-flap reconstruction in head and neck cancer patients. Oral surgery, oral medicine, oral pathology and oral radiology. 2023 Jan;135(1):33-41

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PMID: 35985962

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