Behind the knife, the Surgery Podcast, where we take a behind the scenes intimate look at surgery

from leaders in the Knife. Today we're continuing our

Annals Surgery Journal Club series with Dr. Pierre Cleveen and we are also

joined by Roxanne Stager. So Dr. Clavian is professor and chairman of the Department of

Surgery in Zurich, Switzerland. He completed a PhD in H.P. B. and Liver Transplant Fellowship

in Toronto, Canada prior to a tenure at Duke University.

And now he's back in Switzerland.

He's on multiple editorial boards,

and as a surgeon scientist has been very active in research. His name may sound familiar to you as one half of the Clavian dindo classification of surgical complications.

He is joining us today to discuss a paper titled The Comprehensive Complication Index is a novel cost assessment tool for surgical procedures.

And like I said, we are also joined by the first author of this paper Roxanne who is completing

her PhD and this is part of the project. Okay thank you very much for the

levitation and for your interest in this other study on outcome research.

Thank you so much for joining us.

I will start off our discussion and my first question for you both is,

what inspired you to do the study?

So maybe I start with this question since it's important to have good

ideas and do something that is relevant.

For many years, doctor, surgeon, we're not so much involved in health economy.

We basically ignore this topic over the past decade. It no doubt that we must be also involved. We have

figures coming from our administration and others payers who are complaining that we are too expensive so we must go in

this field too. The idea here was to develop a tool or something that is easy accessible, that we understand easily that give us some information about the cost of a procedure of a group of a group of patients. The first observation that we made and with other

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