Improving surgical outcome reporting in lithiasis surgery: a comparative analysis of comprehensive complication index and clavien-dindo classification.

BACKGROUND

Accurate complication reporting in endourology remains challenging, with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems. This study aimed to compare surgical outcomes and complication reporting in ureterolithotripsy (URL), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL) using both systems.

METHODS

This prospective, single-center, non-interventional study included 473 patients undergoing URL, PCNL, or ESWL from October 2022 to October 2024. Demographic, stone-related, and procedural variables were recorded. Complications were classified using the CDC, and cumulative morbidity was assessed using CCI. Statistical analyses, including univariate and multivariate regression, were performed to identify predictors of higher CCI scores.

RESULTS

PCNL was associated with the highest complication rates, including an 11% transfusion rate. ESWL had the lowest complication burden, while URL demonstrated intermediate risk. CCI scores correlated positively with length of stay (LOS; r = 0.47), highlighting its ability to capture overall morbidity. Multivariate analysis identified stone size, operating time, and positive urine culture as significant predictors of higher CCI scores. The CCI provided a more comprehensive representation of morbidity compared to the CDC.

CONCLUSIONS

CCI demonstrates superior sensitivity in evaluating postoperative morbidity compared to CDC, particularly in more invasive procedures such as PCNL. Standardized reporting frameworks incorporating CCI may enhance surgical outcome assessment in endourology.