The Comprehensive Complication Index in Postoperative Assessment After Head and Neck Reconstruction

Background Postoperative complications significantly impact outcomes in head and neck free‐flap reconstruction. The comprehensive complication index (CCI) offers a continuous measure of complication burden but is rarely applied in head and neck surgery compared to the Clavien‐Dindo Classification (CDC). Methods This retrospective study analyzed 354 patients who underwent head and neck free‐flap reconstruction. Complications were graded using the CDC, and the CCI was calculated. Multivariable linear regression was used to identify risk factors for increased CCI values. Results A total of 413 complications were observed in 252 patients. Analysis using the CCI identified mandibular reconstruction, diabetes mellitus, and prolonged operative time as significant risk factors for increased complication burden, while analysis using the CDC identified only prolonged operative time. Conclusions The CCI provides a comprehensive assessment of postoperative morbidity and demonstrates potential for improved evaluation of complication burden in head and neck free‐flap reconstruction. Level of Evidence Level IV. Clinical Trial Registration This study was registered in the UMIN Clinical Trials Registry as UMIN000055625 ( http://www.umin.ac.jp/ctr ).