Comparative Analysis of Two Methods for Assessing Complications in Pediatric Surgery for Extravisceral Neck Tumors: A Cohort Study



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Abstract

BACKGROUND: The lack of a unified approach to assessing postoperative complications in children with extravisceral neck tumors hinders risk stratification and selection of the optimal management strategy.

AIM: The study aimed to compare the prognostic accuracy of the Clavien–Dindo classification (CDC) and Comprehensive Complication Index (CCI) for predicting prolonged hospitalization (>8 days) and adverse oncologic outcomes.

METHODS: Data from 153 patients (≤17 years) who underwent extravisceral neck tumor resection at the Dmitry Rogachev National Medical Research Center between 2012 and 2022 were analyzed. Postoperative complications were graded using CDC and CCI. Univariable and multivariable logistic regression, Cox regression, survival analysis, and ROC analysis were performed, and model comparison techniques were applied.

RESULTS: Of the operated children, the median age was 2.9 years (1.2–8.3; 0.1–17.9), and 49% were boys. Severe complications (CDC ≥IIIa) were conventionally reported in 13.1% of patients (20/153), whereas minor complications were determined in 24.8% (38/153). The median CCI for the entire cohort was 0 (0–20.9) and 21.8 (8.7–32.4) among those with recorded complications. Using CCI, 22.2% (34/153) of patients were identified to have severe complications (CCI ≥26.2), versus 13.1% (20/153) using CDC ≥ IIIa. Prognostic models using either CCI or CDC showed comparable discrimination (AUC >0.84), sensitivity of 62.7%–68.7%, and specificity of 80.2%–83.7%. The model including CCI retained advantages by information criteria, whereas the CDC-based model may be clinically useful when complication classification needs to be considered. Complications were not associated with local recurrence or with overall survival.

CONCLUSION: Combined CCI and CDC enable more precise stratification by complication severity and, when incorporated into a prognostic model, accurately predicts prolonged hospitalization in approximately 8 of 10 patients.

About the authors

Georgy A. Polev

Dmitry Rogachev National Medical Research Center for Children's Hematology, Oncology and Immunology; Ilyinskaya hospital

Author for correspondence.
Email: dr.polev@gmail.com
ORCID iD: 0000-0002-7175-6417
SPIN-code: 7778-3356

MD, Cand. Sci. (Medicine), Senior researcher of the Department of Head and Neck Surgery and Reconstructive Plastic Surgery; Director of the Head and Neck Surgery Center

Russian Federation, Moscow; Krasnogorsk

Nikolai S. Grachev

Dmitry Rogachev National Medical Research Center for Children's Hematology, Oncology and Immunology

Email: nick-grachev@yandex.ru
ORCID iD: 0000-0002-4451-3233
SPIN-code: 2836-2349

MD, Dr. Sci. (Medicine), Professor, General Director

Russian Federation, Moscow

Raisa S. Oganesyan

Dmitry Rogachev National Medical Research Center for Children's Hematology, Oncology and Immunology

Email: raisaoganesyan@gmail.com
ORCID iD: 0000-0002-1698-2956
SPIN-code: 3617-0340

Pediatric Surgeon, Depart. of Oncology, Head and Neck Surgery and Neurosurgery

Russian Federation, Moscow

Ekaterina Iu. Iaremenko

Dmitry Rogachev National Medical Research Center for Children's Hematology, Oncology and Immunology

Email: selvaggio@yandex.ru
ORCID iD: 0000-0003-1196-5070
SPIN-code: 3203-9151
Scopus Author ID: 57202806377

Laboratory assistant, Depart. of Head and Neck Surgery and Reconstructive Plastic Surgery

Russian Federation, Moscow

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