General Surgery

Comprehensive Complication Index outperforms Clavien–Dindo for quantifying postoperative morbidity

This systematic review included 79 studies evaluating grading scales for adult postoperative complications across surgical specialties. The Clavien–Dindo Classification (CDC) and Comprehensive Complication Index (CCI) were the most frequently used systems. Of 36 studies directly comparing CCI to CDC, 33 (92%) found CCI superior using outcomes such as length of stay or cost. CCI correlated better with length of stay than CDC in 26 of 27 studies that used LOS as the comparator outcome. Authors advocate CCI for research and benchmarking, while acknowledging CDC’s practicality for routine clinical care when tailored to specialty needs. 1

Postoperative delirium in NSQIP: under-screened yet strongly prognostic of poor outcomes

This ACS-NSQIP analysis included 217,783 adults with documented delirium assessment plus 2.7 million unscreened surgical patients. Delirium screening was performed only in patients aged ≥75 years and covered just 7.3% of all surgical patients. Among screened patients, delirium incidence was 10.6% and rose with age, reaching 12.8% in those ≥90 years. Delirium was associated with older age, functional dependence, higher ASA class, dementia, recent falls, urgent surgery, and longer operative time. It independently increased 30-day mortality (OR 3.2), reoperation, surgical complications, loss of independence, and non-home discharge. Findings highlight major gaps in delirium detection and support broader, standardized perioperative screening and prevention strategies. 2

Regional anaesthesia, not intra-op opioids, drives better postoperative pain outcomes

This network meta-analysis synthesized 885 randomized trials comparing opioid-free vs opioid-inclusive anaesthesia, with or without regional techniques, in adults. Strategies incorporating regional anaesthesia consistently ranked best for postoperative pain at 2, 12, and 48 hours. With regional anaesthesia, differences between opioid-free and opioid-inclusive techniques in pain outcomes were minimal. Regional anaesthesia plus opioid-free anaesthesia ranked best for reducing postoperative opioid consumption across time points. Techniques without regional anaesthesia had higher pain scores, greater opioid requirements, and more postoperative nausea and vomiting. 3