The economic burden of postoperative complications measured by the Comprehensive Complication Index® occurring in patients undergoing elective major hepatopancreaticobiliary surgery in a London tertiary referral hospital – A prospective health economics study

• Postoperative complications have a tremendous impact on in-hospital costs per case and complications. 
• The novel Comprehensive Complication Index^® (CCI^®) summarizes all postoperative complications and is more sensitive than existing morbidity endpoints.
• The purpose of this study is to:
  • Assess the correlation of CCI^® with in-hospital costs.
  • Establish the cost per unit of CCI for each different procedure. 
  • Assess the economic burden they represent.
• This will be a prospective study including all consecutive patients undergoing elective major hepatopancreaticobiliary surgery at the Royal Free Hospital in London.
• Data collection will include:
  • Patient demographics
  • Comorbidities
  • Disease and operation characteristics
  • Postoperative morbidity
  •  Intensive care unit and hospital stay
  • Mortality.
• The total costs per patient will be obtained from the finance department of the hospital.
• Fully anonymised data will be collected without any patient identifiers.
• In the pilot phase of this study, a sample size calculation using the standard bivariate model, with a two-sided alpha of 0.05 and power of 0.80, will be conducted after having included 30 cases to estimate the correlation coefficient of the CCI^® with the total in-hospital costs.
• Univariate analysis will include correlation of the CCI^® with costs, overall and the subgroups of the different procedures (complex biliary, minor and major liver surgery, pancreatic surgery).
• The CCI^® as well as the absolute in-hospital costs will be compared among the different types of procedures with non-parametric tests.
• Multivariate linear regression analysis will be performed using a multivariate linear regression model adjusted for potential confounders.  
• This study will highlight a relevant savings capacity for major surgical procedures and supports all efforts to lower negative events in the postoperative course. 

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