Geiger Scott, Kocher Neil, Illinsky Dan, Xylinas Evanguelos, Chang Peter, Dewey Lauren, Wagner Andrew A, Petros Firas, Matin Surena F, Tobert Conrad, Tracy Chad, Patard Pierre-Marie, Roumiguie Mathieu, Monteiro Leonardo Lima, Kassouf Wassim, Raman Jay D
Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Department of Urology, Cochin Hospital, Paris Descartes, CPSC, France.
Transl Androl Urol. 2020 Aug;9(4):1780-1785. doi: 10.21037/tau.2020.01.16.
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.
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].
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 5.4 days, P<0.01) and hospital readmission (OR 3.2, 95% CI: 1.9-5.6, P=0.02) after RNU.
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.
根治性肾输尿管切除术（RNU）后20%-40%的患者会出现并发症。综合并发症指数（CCI）是一种替代Clavien-Dindo（CD）分级系统的分级系统，它以连续（而非分类）量表汇总患者经历的所有并发症。我们研究CCI的累积性质在预测RNU术后围手术期过程方面是否优于CD。
回顾了2005年至2015年在7家学术医疗中心接受RNU的596例患者的记录。使用CD和CCI分类系统对RNU后30天内发生的并发症进行标注。采用逻辑回归确定CD和CCI与围手术期协变量以及康复指标[住院时间（LOS）和再入院]之间的关联。
共纳入377例男性和219例女性，中位年龄71岁，BMI为27，Charlson合并症评分为4。超过一半的患者接受了微创RNU。RNU后的中位LOS为6.0天（范围1-37天），45例（8%）患者在30天内再次入院。总体而言，136例患者（23%）发生术后并发症，其中91例有单一并发症，45例有多种并发症（范围2-6种）；44例（7%）患者发生Clavien III级或更高级别的并发症，发生并发症的患者的中位CCI为20.9（范围8.7-100）。CCI的上四分位数（≥75%）和主要CD并发症均与较高的基线Charlson评分、ECOG≥2以及CKD分期≥III相关（均P<0.05）。然而，只有CCI的上四分位数与RNU后的LOS（8.9±5.4天，P<0.01）和医院再入院（OR 3.2，95%CI：1.9-5.6，P=0.02）相关。
CD和CCI分类系统与RNU患者的基线和围手术期特征相似。然而，CCI的累积性质能够更好地预测RNU术后的病程，包括LOS和再入院情况。
