Objective: Gastro-duodenal perforation is a life-threatening surgical emergency associated with high morbidity and mortality, particularly in low- and middle-income countries due to delayed presentation and sepsis. Accurate assessment of postoperative complications is essential for predicting outcomes. While the Clavien-Dindo classification (CDC) is widely used, it records only the highest-grade complication, potentially underestimating overall morbidity. The comprehensive complication index (CCI), a continuous scale incorporating all complications, may provide better prognostic value. Material and Methods: This prospective observational study was conducted over 18 months in a tertiary care centre in northern India and included 50 adult patients with gastro-duodenal perforation. Postoperative complications were graded using CDC and quantified using CCI. Associations with length of hospital stay (LOS) were analysed using ANOVA, Pearson's correlation, and multivariate linear regression. Conclusion: The CCI is a superior predictor of postoperative morbidity and hospital stay compared to CDC, particularly in patients with lower-grade CDC complications, as it more comprehensively reflects the cumulative burden of complications.
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Faiz et al. (2026) studied this question.
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