Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Eur Urol. 2018 Jul;74(1):4-7. doi: 10.1016/j.eururo.2018.02.025. Epub 2018 Mar 12.
The rate of postoperative complications might vary according to the method used to collect perioperative data. We aimed at assessing the impact of the prospective implementation of the European Association of Urology (EAU) guidelines on reporting and grading of complications in prostate cancer patients undergoing robot-assisted radical prostatectomy (RARP). From September 2016, an integrated method for reporting surgical morbidity based on the EAU guidelines was implemented at a single, tertiary center. Perioperative data were prospectively and systematically collected during a patient interview at 30 d after surgery as recommended by the EAU Guidelines Panel Recommendations on Reporting and Grading Complications. The rate and grading of complications of 167 patients who underwent RARP±pelvic lymph node dissection (PLND) after the implementation of the prospective collection system (Group 1) were compared with 316 patients treated between January 2015 and August 2016 (Group 2) when a system based on patient chart review was used. No differences were observed in disease characteristics and PLND between the two groups (all p≥0.1). Postoperative complications were graded according to the Clavien-Dindo classification system. Overall, the complication rate was higher when the prospective collection system based on the EAU guidelines was used (29%) than when retrospective chart review (10%; p<0.001) was used. In particular, a substantially higher rate of grade 1 (8.4% vs 4.7%) and 2 (14% vs 2.8%) complications was detected in Group 1 versus Group 2 (p<0.001). Although the rate of complications occurred during hospitalization did not differ (13% vs 10%; p=0.3), 31 (19%) complications after discharge were detected in Group 1. This resulted into a readmission rate of 16%. Conversely, no complications after discharge and readmissions were recorded for Group 2. The implementation of the EAU guidelines on reporting perioperative outcomes roughly doubled the complication rate after RARP and allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed, where patients assessed with the EAU implemented protocol had a threefold higher likelihood of reporting complications.
The implementation of the European Association of Urology guidelines on reporting and grading of complications after urologic procedures in prostate cancer patients roughly doubled the complication rate after robot-assisted radical prostatectomy compared to retrospective patient chart review. Moreover, it allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed.
术后并发症的发生率可能因收集围手术期数据的方法而异。我们旨在评估在接受机器人辅助根治性前列腺切除术 (RARP) 的前列腺癌患者中，前瞻性实施欧洲泌尿外科学会 (EAU) 指南对报告和分级并发症的影响。自 2016 年 9 月起，在单一的三级中心，采用基于 EAU 指南的综合方法报告手术发病率。根据 EAU 指南小组对报告和分级并发症的建议，在术后 30 天对患者进行采访时，前瞻性且系统地收集围手术期数据。将实施前瞻性采集系统后 (第 1 组) 接受 RARP±盆腔淋巴结清扫术 (PLND) 的 167 例患者的并发症发生率和分级与 2015 年 1 月至 2016 年 8 月期间接受基于患者病历回顾的系统治疗的 316 例患者 (第 2 组) 进行比较。两组患者的疾病特征和 PLND 无差异 (均 p≥0.1)。术后并发症根据 Clavien-Dindo 分类系统分级。总体而言，当使用基于 EAU 指南的前瞻性采集系统时，并发症发生率高于使用回顾性病历回顾 (10%；p<0.001)。特别是，第 1 组中更高级别的并发症发生率明显更高，1 级 (8.4% vs 4.7%) 和 2 级 (14% vs 2.8%) (p<0.001)。尽管住院期间并发症发生率无差异 (13% vs 10%；p=0.3)，但第 1 组中仍有 31 例 (19%) 出院后并发症。这导致再入院率为 16%。相反，第 2 组出院后和再入院均未记录并发症。报告围手术期结局的 EAU 指南的实施使 RARP 后并发症的发生率增加了近两倍，并能够在超过 15%的患者中检测到出院后并发症，而采用 EAU 实施方案评估的患者报告并发症的可能性高出三倍。
与回顾性患者病历回顾相比，在接受泌尿科手术的前列腺癌患者中实施报告和分级并发症的 EAU 指南使 RARP 后并发症的发生率增加了近两倍。此外，它还可以在超过 15%的原本可能遗漏的患者中检测到出院后的并发症。
