Abstract
The Clavien-Dindo Classification remains the most widely accepted method for grading surgical complications. The Comprehensive Complication Index, a continuous scale integrating all postoperative events, may provide a more comprehensive overview. This study compared the sensitivity and clinical applicability of the Clavien-Dindo Classification and the Comprehensive Complication Index in assessing complications following ureteroscopic stone surgery. In this multicenter prospective study, data from patients undergoing ureteroscopic stone surgery were collected, including demographic, perioperative, and complication variables. Complications were graded using the Clavien-Dindo Classification, and cumulative morbidity was subsequently calculated using the Comprehensive Complication Index based on assigned Clavien-Dindo grades. Patients were stratified by minor (I-II) or major (≥ III) complications. Correlation analyses between complication scores and clinical parameters, including comorbidity indices and hospital stay, were performed. A total of 1607 patients were included; 98 (6.1%) experienced complications. Comprehensive Complication Index showed a numerically higher correlation with hospital stay in patients with minor complications, whereas Clavien-Dindo Classification showed a numerically higher correlation in patients with major complications; however, formal statistical comparison of these correlations did not demonstrate a significant difference between the two systems. In 39 patients, Comprehensive Complication Index exceeded corresponding the Clavien-Dindo Classification grade, suggesting improved sensitivity for overall morbidity. Both systems showed moderate correlations with comorbidity indices and hospital stay; however, the Comprehensive Complication Index performed better with multiple minor complications. Limitations of this study include its observational nature, the lack of long-term patient-reported quality of life outcomes, and potential variations in surgeon experience across the participating centers. Comprehensive Complication Index provides refined reflection of cumulative minor complications, while Clavien-Dindo Classification offers clearer categorization of major events. Neither system demonstrated absolute superiority; however, their combined application may enhance complication reporting and facilitate comprehensive outcome assessment in ureteroscopic stone surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (https//clinicaltrials.gov), NCT06394908.