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Geiger S, Kocher N, Illinsky D, Xylinas E, Chang P, Dewey L, Wagner AA, Petros F, Matin SF, Tobert C, Tracy C, Patard PM, Roumiguie M, Monteiro LL, Kassouf W, Raman JD. Comparison of the Comprehensive Complication Index and Clavien-Dindo systems in predicting perioperative outcomes following radical nephroureterectomy. Transl Androl Urol 2020; 9:1780-1785. [PMID: 32944540 PMCID: PMC7475662 DOI: 10.21037/tau.2020.01.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Complications can occur following radical nephroureterectomy (RNU) in 20–40% of patients. The Comprehensive Complication Index (CCI) is an alternative grading system to the Clavien-Dindo (CD) grading system that aggregates all complications experienced by a patient on a continuous (as opposed to categorical) scale. We investigate whether the cumulative nature of CCI renders it superior to CD in predicting perioperative course after RNU. Methods The records of 596 patents who underwent RNU at 7 academic medical centers from 2005 to 2015 were reviewed. Complications occurring within 30 days of RNU were annotated using both the CD and CCI classification systems. Logistic regression was used to determine associations between CD and CCI with perioperative covariates as well as measures of convalescence [hospital length of stay (LOS) and readmission]. Results A total of 377 men and 219 women with a median age of 71, BMI of 27, and Charlson comorbidity score of 4 were included. Over half underwent a minimally invasive RNU. Median LOS following RNU was 6.0 days (range, 1–37 days) and readmission within 30-days occurred in 45 (8%) patients. Overall, 136 patients (23%) experienced a post-operative complication with 91 having a single complication and 45 with multiple (range, 2–6); 44 (7%) patients had Clavien III or greater complications, and the median CCI for those patients experiencing a complication was 20.9 (range, 8.7–100). Both the upper quartile of CCI (≥75th %) and major CD complications were associated with higher baseline Charlson score, ECOG ≥2, and CKD stage ≥ III (all P<0.05). However, only the upper quartile of CCI was associated with LOS (8.9 vs. 5.4 days, P<0.01) and hospital readmission (OR 3.2, 95% CI: 1.9–5.6, P=0.02) after RNU. Conclusions The CD and CCI classification systems both are associated with similar baseline and perioperative characteristics for RNU patients. However, the cumulative nature of the CCI allows for superior prediction of postoperative course after RNU including LOS and readmission.
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Affiliation(s)
- Scott Geiger
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Neil Kocher
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dan Illinsky
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Peter Chang
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lauren Dewey
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew A Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Firas Petros
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Conrad Tobert
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | - Chad Tracy
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | - Pierre-Marie Patard
- Urology Service, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Mathieu Roumiguie
- Urology Service, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Wassim Kassouf
- Department of Urology, McGill University, Montreal, Canada
| | - Jay D Raman
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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