Dados do Trabalho

Título

Is it worth using the Comprehensive Complication Index over the Clavien-Dindo Classification in elderly patients who underwent percutaneous nephrolithotomy?

Resumo

The Clavien-Dindo Classification (CDC), although widely used, is limited by accounting only the most severe complication, what has spurred efforts to develop a more accurate scoring system. In response to this need, the Comprehensive Complication Index (CCI) has emerged as a score based on CDC that considers multiple complications. The aim of this study is to compare the CCI to the CDC in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population. For this purpose, we conducted a retrospective study involving patients 60 years and older who underwent standard PCNL at our institution between 2009 and 2020. Approval was granted by the local research ethics committee. Postoperative complications were considered up to 30 days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications. We included 239 patients with a median age of 65 [63-70] years. 15.5% presented complications and multiple complications occurred in 2.9% of the patients. LOS had a correlation coefficient of 0.291 (p < 0.001) with both CDC and CCI. Admission to the ER had a coefficient of 0.284 (p < 0.001) with CDC and 0.286 (p < 0.001) with CCI. Higher American Anesthesiology Association (ASA) physical status (p = 0.04), higher Guy’s Hospital Kidney Stone Classification (p = 0.02) and lower post-surgery hematocrit level (p = 0.046) exhibited significant univariate correlations with complications. After multivariate analysis, only a higher ASA physical status (p = 0.01) showed independent correlation with complications, therefore arising as a unique predictor of complications following PCNL in the elderly population. We conclude that the use of the CCI following this procedure in this population did not yield benefits over the widely used CDC.

Palavras Chave

Elderly; Percutaneous nephrolithotomy; Postoperative complications