Comparison of the Clavien-Dindo and Comprehensive Complication Index systems for grading of surgical complications after colorectal resections
Postoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was developed as a scoring system that does not only take the most severe complication into account but all complications after surgery. Our aim was to...
Saved in:
| Published in: | Acta chirurgica belgica Vol. 122; no. 6; pp. 403 - 410 |
|---|---|
| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Taylor & Francis
02.11.2022
|
| Subjects: | |
| ISSN: | 0001-5458 |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Abstract | Postoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was developed as a scoring system that does not only take the most severe complication into account but all complications after surgery. Our aim was to compare the Clavien-Dindo scoring system with the CCI in predicting length of hospital stay (LOHS) and in-hospital costs after colorectal resections.
Complications occurring after surgical procedures, performed between October 2012 and September 2013, were prospectively recorded. During this period 164 patients developed complication(s). Only patients that underwent a colorectal resection were included. Multivariable linear regression analysis was performed to find independent predictors of in-hospital costs and LOHS.
64 patients (age (range): 69 (10-91) years, M/F: 36/28) were retained. 46 (71.9%) patients had a Clavien-Dindo score ≥ IIIb. Median (IQR) CCI was 40 (30.2-53.9). Mean (±SD) in-hospitals costs for all patients were €12,920 ± €10,229. The adjusted difference (95% CI, p-value) in in-hospital costs for minor and major (Clavien-Dindo ≥ IIIb) complications was 10,021 (€4283 to €15,759, p = 0.001). A 10 point increase in CCI increased in-hospital costs by €2040. Multivariable analysis retained CCI > 40 as the only independent risk factor for increased in-hospital costs (Standard Beta Coeffic (p-value): 8063 (p = 0.022).
CCI is a better predictor of in-hospital costs than Clavien-Dindo score to classify complications after colorectal resections, as it captures all complications. Further research is warranted to extrapolate our findings to other sub-specialities of surgery. |
|---|---|
| AbstractList | Postoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was developed as a scoring system that does not only take the most severe complication into account but all complications after surgery. Our aim was to compare the Clavien-Dindo scoring system with the CCI in predicting length of hospital stay (LOHS) and in-hospital costs after colorectal resections.INTRODUCTIONPostoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was developed as a scoring system that does not only take the most severe complication into account but all complications after surgery. Our aim was to compare the Clavien-Dindo scoring system with the CCI in predicting length of hospital stay (LOHS) and in-hospital costs after colorectal resections.Complications occurring after surgical procedures, performed between October 2012 and September 2013, were prospectively recorded. During this period 164 patients developed complication(s). Only patients that underwent a colorectal resection were included. Multivariable linear regression analysis was performed to find independent predictors of in-hospital costs and LOHS.METHODSComplications occurring after surgical procedures, performed between October 2012 and September 2013, were prospectively recorded. During this period 164 patients developed complication(s). Only patients that underwent a colorectal resection were included. Multivariable linear regression analysis was performed to find independent predictors of in-hospital costs and LOHS.64 patients (age (range): 69 (10-91) years, M/F: 36/28) were retained. 46 (71.9%) patients had a Clavien-Dindo score ≥ IIIb. Median (IQR) CCI was 40 (30.2-53.9). Mean (±SD) in-hospitals costs for all patients were €12,920 ± €10,229. The adjusted difference (95% CI, p-value) in in-hospital costs for minor and major (Clavien-Dindo ≥ IIIb) complications was 10,021 (€4283 to €15,759, p = 0.001). A 10 point increase in CCI increased in-hospital costs by €2040. Multivariable analysis retained CCI > 40 as the only independent risk factor for increased in-hospital costs (Standard Beta Coeffic (p-value): 8063 (p = 0.022).RESULTS64 patients (age (range): 69 (10-91) years, M/F: 36/28) were retained. 46 (71.9%) patients had a Clavien-Dindo score ≥ IIIb. Median (IQR) CCI was 40 (30.2-53.9). Mean (±SD) in-hospitals costs for all patients were €12,920 ± €10,229. The adjusted difference (95% CI, p-value) in in-hospital costs for minor and major (Clavien-Dindo ≥ IIIb) complications was 10,021 (€4283 to €15,759, p = 0.001). A 10 point increase in CCI increased in-hospital costs by €2040. Multivariable analysis retained CCI > 40 as the only independent risk factor for increased in-hospital costs (Standard Beta Coeffic (p-value): 8063 (p = 0.022).CCI is a better predictor of in-hospital costs than Clavien-Dindo score to classify complications after colorectal resections, as it captures all complications. Further research is warranted to extrapolate our findings to other sub-specialities of surgery.CONCLUSIONCCI is a better predictor of in-hospital costs than Clavien-Dindo score to classify complications after colorectal resections, as it captures all complications. Further research is warranted to extrapolate our findings to other sub-specialities of surgery. Postoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was developed as a scoring system that does not only take the most severe complication into account but all complications after surgery. Our aim was to compare the Clavien-Dindo scoring system with the CCI in predicting length of hospital stay (LOHS) and in-hospital costs after colorectal resections. Complications occurring after surgical procedures, performed between October 2012 and September 2013, were prospectively recorded. During this period 164 patients developed complication(s). Only patients that underwent a colorectal resection were included. Multivariable linear regression analysis was performed to find independent predictors of in-hospital costs and LOHS. 64 patients (age (range): 69 (10-91) years, M/F: 36/28) were retained. 46 (71.9%) patients had a Clavien-Dindo score ≥ IIIb. Median (IQR) CCI was 40 (30.2-53.9). Mean (±SD) in-hospitals costs for all patients were €12,920 ± €10,229. The adjusted difference (95% CI, -value) in in-hospital costs for minor and major (Clavien-Dindo ≥ IIIb) complications was 10,021 (€4283 to €15,759, = 0.001). A 10 point increase in CCI increased in-hospital costs by €2040. Multivariable analysis retained CCI > 40 as the only independent risk factor for increased in-hospital costs (Standard Beta Coeffic ( -value): 8063 ( = 0.022). CCI is a better predictor of in-hospital costs than Clavien-Dindo score to classify complications after colorectal resections, as it captures all complications. Further research is warranted to extrapolate our findings to other sub-specialities of surgery. Postoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was developed as a scoring system that does not only take the most severe complication into account but all complications after surgery. Our aim was to compare the Clavien-Dindo scoring system with the CCI in predicting length of hospital stay (LOHS) and in-hospital costs after colorectal resections. Complications occurring after surgical procedures, performed between October 2012 and September 2013, were prospectively recorded. During this period 164 patients developed complication(s). Only patients that underwent a colorectal resection were included. Multivariable linear regression analysis was performed to find independent predictors of in-hospital costs and LOHS. 64 patients (age (range): 69 (10-91) years, M/F: 36/28) were retained. 46 (71.9%) patients had a Clavien-Dindo score ≥ IIIb. Median (IQR) CCI was 40 (30.2-53.9). Mean (±SD) in-hospitals costs for all patients were €12,920 ± €10,229. The adjusted difference (95% CI, p-value) in in-hospital costs for minor and major (Clavien-Dindo ≥ IIIb) complications was 10,021 (€4283 to €15,759, p = 0.001). A 10 point increase in CCI increased in-hospital costs by €2040. Multivariable analysis retained CCI > 40 as the only independent risk factor for increased in-hospital costs (Standard Beta Coeffic (p-value): 8063 (p = 0.022). CCI is a better predictor of in-hospital costs than Clavien-Dindo score to classify complications after colorectal resections, as it captures all complications. Further research is warranted to extrapolate our findings to other sub-specialities of surgery. |
| Author | Houben, Bert Smeyers, Karel Marie Celine Ivo Sergeant, Gregory Slankamenac, Ksenija |
| Author_xml | – sequence: 1 givenname: Karel Marie Celine Ivo orcidid: 0000-0001-8325-3430 surname: Smeyers fullname: Smeyers, Karel Marie Celine Ivo organization: Department of Abdominal Surgery, Jessa Hospital – sequence: 2 givenname: Ksenija orcidid: 0000-0002-3568-9253 surname: Slankamenac fullname: Slankamenac, Ksenija organization: Department of Visceral and Transplant Surgery, University of Zurich – sequence: 3 givenname: Bert surname: Houben fullname: Houben, Bert organization: Department of Abdominal Surgery, Jessa Hospital – sequence: 4 givenname: Gregory surname: Sergeant fullname: Sergeant, Gregory organization: Department of Abdominal Surgery, Jessa Hospital |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33910493$$D View this record in MEDLINE/PubMed |
| BookMark | eNqFkc1uEzEUhb0ooqX0EUBespngv5mMxQaU8lOpEpt2bTn2dWrksYPtFPISfWY8TYoQC1jZ997vnMU5L9BJTBEQekXJgpKRvCWE0F7044IRRhdUMjKM7ASdzftuPpyii1K-tZEIwsRy-Rydci4pEZKfoYdVmrY6-5IiTg7XO8CroO89xO7SR5uwjhbPTIY7iMXfw-MUvNHVN81VtPATl32pMBXsUsabrK2Pm9mt7PKmgQGbPyQFa1cht11IGUxt5wylfebbS_TM6VDg4vieo9tPH29WX7rrr5-vVh-uO8OHoXbOEgFcCsv4AM5KB5bytV5qDnJkYAUfB87WwAY5jGI9OkOMHfuBUUEJNYSfozcH321O33dQqpp8MRCCjpB2RbGeypEMSyka-vqI7tYTWLXNftJ5r54ybEB_AExOpWRwvxFK1FyReqpIzRWpY0VN9-4vnfH1MaKatQ__Vb8_qH1sqU_6R8rBqqr3LVWXdTS-KP5vi1_3hq3Y |
| CitedBy_id | crossref_primary_10_1097_MS9_0000000000002116 crossref_primary_10_1016_j_asjsur_2025_04_120 crossref_primary_10_1016_j_oraloncology_2025_107430 crossref_primary_10_1007_s13193_025_02247_2 |
| Cites_doi | 10.1097/SLA.0b013e318296c732 10.1111/bju.12219 10.1016/S0140-6736(96)90137-3 10.1016/j.jamcollsurg.2014.12.042 10.1186/1754-9493-8-2 10.1016/S0140-6736(12)61417-2 10.1007/s11605-009-0857-z 10.1016/S0140-6736(12)61148-9 10.1186/1471-2407-4-94 10.1016/j.ciresp.2009.07.004 10.1007/s13304-011-0073-8 10.1097/01.sla.0000133083.54934.ae 10.1016/j.jss.2013.11.1092 10.1186/1754-9493-5-30 10.1097/00000658-199212000-00002 10.1097/00000542-194105000-00004 |
| ContentType | Journal Article |
| Copyright | 2021 The Royal Belgian Society for Surgery 2021 |
| Copyright_xml | – notice: 2021 The Royal Belgian Society for Surgery 2021 |
| DBID | AAYXX CITATION NPM 7X8 |
| DOI | 10.1080/00015458.2021.1920682 |
| DatabaseName | CrossRef PubMed MEDLINE - Academic |
| DatabaseTitle | CrossRef PubMed MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic PubMed |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | fulltext_linktorsrc |
| EndPage | 410 |
| ExternalDocumentID | 33910493 10_1080_00015458_2021_1920682 1920682 |
| Genre | Research Article Journal Article |
| GroupedDBID | --- 0R~ 23M 5GY AAGDL AALUX AAMIU AAPUL AAQRR ABBKH ABEIZ ABLIJ ABUPF ABWVI ABXYU ACENM ACGFS ACIEZ ADCVX AECIN AENEX AFRVT AGDLA AGFJD AGRBW AGYJP AIJEM AIRBT AKBVH ALMA_UNASSIGNED_HOLDINGS ALQZU ALYBC AMDAE AQTUD ARJSQ BABNJ BLEHA BOHLJ CCCUG EBS F5P H13 IPNFZ KYCEM LJTGL M4Z P2P RIG RNANH RVRKI TASJS TBQAZ TDBHL TERGH TFL TFW TUROJ UEQFS AAYXX CITATION 0BK ADYSH NPM 7X8 |
| ID | FETCH-LOGICAL-c366t-fd04e394d236efd9fed13ba7a3e982ed438632be269684b8fc0cd856214101c03 |
| IEDL.DBID | TFW |
| ISICitedReferencesCount | 6 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000656326100001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 0001-5458 |
| IngestDate | Fri Sep 05 10:51:02 EDT 2025 Wed Feb 19 02:25:33 EST 2025 Sat Nov 29 06:32:11 EST 2025 Tue Nov 18 22:37:18 EST 2025 Mon Oct 20 23:47:04 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 6 |
| Keywords | postoperative complications colorectal resections Clavien-Dindo classification Comprehensive Complication Index socio-economic impact of complications |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c366t-fd04e394d236efd9fed13ba7a3e982ed438632be269684b8fc0cd856214101c03 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ORCID | 0000-0002-3568-9253 0000-0001-8325-3430 |
| PMID | 33910493 |
| PQID | 2519806794 |
| PQPubID | 23479 |
| PageCount | 8 |
| ParticipantIDs | crossref_primary_10_1080_00015458_2021_1920682 pubmed_primary_33910493 proquest_miscellaneous_2519806794 informaworld_taylorfrancis_310_1080_00015458_2021_1920682 crossref_citationtrail_10_1080_00015458_2021_1920682 |
| PublicationCentury | 2000 |
| PublicationDate | 2022-11-02 |
| PublicationDateYYYYMMDD | 2022-11-02 |
| PublicationDate_xml | – month: 11 year: 2022 text: 2022-11-02 day: 02 |
| PublicationDecade | 2020 |
| PublicationPlace | England |
| PublicationPlace_xml | – name: England |
| PublicationTitle | Acta chirurgica belgica |
| PublicationTitleAlternate | Acta Chir Belg |
| PublicationYear | 2022 |
| Publisher | Taylor & Francis |
| Publisher_xml | – name: Taylor & Francis |
| References | CIT0010 CIT0001 CIT0012 CIT0011 CIT0003 Clavien PA (CIT0005) 1992; 111 CIT0014 CIT0002 CIT0013 CIT0016 CIT0004 CIT0015 CIT0007 Casadei R (CIT0017) 2011; 12 CIT0018 CIT0006 CIT0009 CIT0008 |
| References_xml | – ident: CIT0003 doi: 10.1097/SLA.0b013e318296c732 – ident: CIT0015 doi: 10.1111/bju.12219 – ident: CIT0004 doi: 10.1016/S0140-6736(96)90137-3 – ident: CIT0009 doi: 10.1016/j.jamcollsurg.2014.12.042 – ident: CIT0018 doi: 10.1186/1754-9493-8-2 – ident: CIT0002 doi: 10.1016/S0140-6736(12)61417-2 – ident: CIT0010 doi: 10.1007/s11605-009-0857-z – volume: 12 start-page: 126 issue: 2 year: 2011 ident: CIT0017 publication-title: JOP – ident: CIT0001 doi: 10.1016/S0140-6736(12)61148-9 – ident: CIT0011 doi: 10.1186/1471-2407-4-94 – ident: CIT0012 doi: 10.1016/j.ciresp.2009.07.004 – ident: CIT0016 doi: 10.1007/s13304-011-0073-8 – ident: CIT0007 doi: 10.1097/01.sla.0000133083.54934.ae – ident: CIT0014 doi: 10.1016/j.jss.2013.11.1092 – volume: 111 start-page: 518 issue: 5 year: 1992 ident: CIT0005 publication-title: Surgery – ident: CIT0008 doi: 10.1186/1754-9493-5-30 – ident: CIT0006 doi: 10.1097/00000658-199212000-00002 – ident: CIT0013 doi: 10.1097/00000542-194105000-00004 |
| SSID | ssj0000402477 |
| Score | 2.331151 |
| Snippet | Postoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was... |
| SourceID | proquest pubmed crossref informaworld |
| SourceType | Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | 403 |
| SubjectTerms | Clavien-Dindo classification colorectal resections Comprehensive Complication Index postoperative complications socio-economic impact of complications |
| Title | Comparison of the Clavien-Dindo and Comprehensive Complication Index systems for grading of surgical complications after colorectal resections |
| URI | https://www.tandfonline.com/doi/abs/10.1080/00015458.2021.1920682 https://www.ncbi.nlm.nih.gov/pubmed/33910493 https://www.proquest.com/docview/2519806794 |
| Volume | 122 |
| WOSCitedRecordID | wos000656326100001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| journalDatabaseRights | – providerCode: PRVAWR databaseName: Taylor & Francis issn: 0001-5458 databaseCode: TFW dateStart: 20020101 customDbUrl: isFulltext: true dateEnd: 99991231 titleUrlDefault: https://www.tandfonline.com omitProxy: false ssIdentifier: ssj0000402477 providerName: Taylor & Francis |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1LT9wwELYo4tBLAUHb5SUjcQ3NekxiH9HCCiSEOEC7tyjxo62EslWy25_Bb2bGTiL2gDjAMUrsxM68PfMNYydnVWby9MwmonLooFjkOZ1Wio4LNXjQYMIJ_s-b_PZWzWb6rssmbLu0SvKhfQSKCLKamLus2j4j7kfanfegdyfGp2iipJkiKYyqn3oY3E9_DVEWJFEh8wiciX4zjerLeF6baEVBrcCXvm6EBmU03fyAZWyxL50lys8j6WyzNVfvsKfJ0JeQzz1H65BPHkvUnXVygd77nOPbOD3TuD8x9T1c9ZE_fk3gizzCQ7ccF8V_NyFLn2Zrl02Qs3wlj52HNuWc0LNJ-uJtqogK5RbtLnuYXt5PrpKuZUNiIMsWibepdKClFZA5b7V3dgxVmZfgtBLOSlAZIFkIwuSRlfImNVahDUbppmOTwle2Xs9r953xrKpKlCcCfOZwPltqLXyJ_p1yTuYGRkz2_6kwHZ45tdV4LMYD7Gnc4II2uOg2eMROh2H_IqDHWwP0SyIoFiGS4mPbkwLeGHvcU0yBbEtnMWXt5su2oIJhRUE8OWLfIikNnwOANpzUsPeON--zz4IKNSgALg7Y-qJZukO2Yf4v_rbNEfuUz9RRYJVnlk4ONw |
| linkProvider | Taylor & Francis |
| linkToHtml | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1Lb9QwELZQQYILFPHaloKRuKZkPd7EPqKFVSuWPS3Qm5X4AUhVFiW7_Iz-5s7YSdQ9VD3AMUrsxM68PfMNY-9ndWHLfOYyUXt0UBzynM5rRceFGgJosPEE__uyXK3UxYW-WQtDaZXkQ4cEFBFlNTE3BaOHlLgPeX_gg-6dmJ6ijZIXCsXw_RnqWqLy9eLHGGdBIhWyTNCZ6DnTsKGQ57aZ9lTUHoDp7WZoVEeLJ_9jIYfscW-M8o-Jep6ye755xq7mY2tCvgkcDUQ-v6xQfTbZJ3TgNxxfx-mZ1v9K2e_xagj-8XPCX-QJIbrjuCr-s42J-jRbt2ujqOV7qew8dirnBKBNAhhvU1FUrLjonrNvi8_r-VnWd23ILBTFNgsulx60dAIKH5wO3k2hrsoKvFbCOwmqAKQMQbA8slbB5tYpNMMo43Rqc3jBDppN418xXtR1hSJFQCg8zucqrUWo0MVT3svSwoTJ4UcZ20OaU2eNSzMdkU_TBhvaYNNv8ISdjsP-JEyPuwbom1RgtjGYElLnEwN3jH03kIxBzqXjmKrxm11nqGZYURxPTtjLREvj5wCgGSc1HP3Dm9-yh2frr0uzPF99OWaPBNVtUDxcvGYH23bnT9gD-3f7u2vfRI65Bk50EXo |
| linkToPdf | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1Lb9QwELZQQYgLD_Ha8jIS15Ssx3XsI9qyoqJa9VCgNyvxgyJV2SrZ5Wf0NzNjJxF7qHqAY5SMEzsz45nxzDeMfThslKvKQ1-IJqCD4lHmTNloOi40EMGASyf430-q1Uqfn5vTIZuwH9IqyYeOGSgi6WoS7isfx4y4j-Vw3oPenZgfoIlSKo1a-C6azor8r7PljynMgjwqZJWRM9FxJrKxjuemkXZ2qB380put0LQbLR_9h3k8Zg8HU5R_yrzzhN0J7VN2vZgaE_J15Gge8sVljZtnWxyh-77m-DZOz3ThIue-p6sx9MePCX2RZ3zonuOk-M8upenTaP22S4qW7ySy89SnnBN8NqlfvE0lUaneon_Gvi0_ny2-FEPPhsKBUpsi-lIGMNILUCF6E4OfQ1NXNQSjRfAStALkC0GgPLLR0ZXOazTCKN907kp4zvbadRteMq6apkaFIiCqgOP52hgRa3TwdAiycjBjcvxP1g2A5tRX49LOJ9zTvMCWFtgOCzxjBxPZVUb0uI3A_M0EdpNCKTH3PbFwC-37kWMsyi0dxtRtWG97SxXDmqJ4csZeZFaaPgcAjThpYP8f3vyO3T89WtqT49XXV-yBoKINCoaL12xv023DG3bP_d786ru3SV7-AAHTECs |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Comparison+of+the+Clavien-Dindo+and+Comprehensive+Complication+Index+systems+for+grading+of+surgical+complications+after+colorectal+resections&rft.jtitle=Acta+chirurgica+belgica&rft.au=Smeyers%2C+Karel+Marie+Celine+Ivo&rft.au=Slankamenac%2C+Ksenija&rft.au=Houben%2C+Bert&rft.au=Sergeant%2C+Gregory&rft.date=2022-11-02&rft.issn=0001-5458&rft.volume=122&rft.issue=6&rft.spage=403&rft.epage=410&rft_id=info:doi/10.1080%2F00015458.2021.1920682&rft.externalDBID=n%2Fa&rft.externalDocID=10_1080_00015458_2021_1920682 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0001-5458&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0001-5458&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0001-5458&client=summon |