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The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind?
PURPOSE: To validate the comprehensive complication index (CCI) for mini-percutaneous nephrolithotomy (mPCNL). METHODS: Data from 287 patients who underwent mPCNL were analyzed. Complications after mPCNL were classified using both the CCI and the Clavien–Dindo classification (CDC). Descriptive stati...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Berlin Heidelberg
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9236985/ https://www.ncbi.nlm.nih.gov/pubmed/35643945 http://dx.doi.org/10.1007/s00345-022-04045-9 |
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author | Boeri, Luca Turetti, Matteo Silvani, Carlo Fulgheri, Irene Jannello, Letizia Maria Ippolita Garbagnati, Susanna Malfatto, Matteo Galbiati, Gilda Pozzi, Efrem Zanetti, Stefano Paolo Longo, Fabrizio De Lorenzis, Elisa Albo, Giancarlo Salonia, Andrea Montanari, Emanuele |
author_facet | Boeri, Luca Turetti, Matteo Silvani, Carlo Fulgheri, Irene Jannello, Letizia Maria Ippolita Garbagnati, Susanna Malfatto, Matteo Galbiati, Gilda Pozzi, Efrem Zanetti, Stefano Paolo Longo, Fabrizio De Lorenzis, Elisa Albo, Giancarlo Salonia, Andrea Montanari, Emanuele |
author_sort | Boeri, Luca |
collection | PubMed |
description | PURPOSE: To validate the comprehensive complication index (CCI) for mini-percutaneous nephrolithotomy (mPCNL). METHODS: Data from 287 patients who underwent mPCNL were analyzed. Complications after mPCNL were classified using both the CCI and the Clavien–Dindo classification (CDC). Descriptive statistics and linear/logistic regression analyses detailed the association between clinical predictors and mPCNL outcomes. RESULTS: After mPCNL, 83 (28.9%) patients had complications, of which 12 (4.2%) patients with multiple complications had a higher CCI score compared to the traditional CDC system accounting only for the highest grade. The CCI enabled a more accurate prediction of length of stay (LOS) than CDC (CCI: r = 0.32; p < 0.01 vs. CDC: r = 0.26; p = 0.01). Patients with multiple complications had higher stone volume (p = 0.02), longer operative time and LOS (all p < 0.01). A higher rate of post-operative hospital readmission (33.3% vs. 9.9%, p = 0.02) and lower rate of stone free (33.3% vs. 64.7%, p = 0.04) were found in patients with multiple complications than in those with single complication. Linear regression analysis revealed that multiple complications were associated with longer LOS (p < 0.001) after accounting for BMI and stone volume. Similarly, having multiple complications was associated with fivefold higher risk of readmission (p = 0.02). CONCLUSION: The CCI is a valuable metric for assessing post-operative complications after mPCNL. The cumulative CCI is a better predictor of LOS than the CDC for mPCNL. Minor complications not captured by the highest CDC score are relevant since patients with multiple complications have longer LOS and higher rate of readmission than those with single ones. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00345-022-04045-9. |
format | Online Article Text |
id | pubmed-9236985 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-92369852022-06-29 The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind? Boeri, Luca Turetti, Matteo Silvani, Carlo Fulgheri, Irene Jannello, Letizia Maria Ippolita Garbagnati, Susanna Malfatto, Matteo Galbiati, Gilda Pozzi, Efrem Zanetti, Stefano Paolo Longo, Fabrizio De Lorenzis, Elisa Albo, Giancarlo Salonia, Andrea Montanari, Emanuele World J Urol Original Article PURPOSE: To validate the comprehensive complication index (CCI) for mini-percutaneous nephrolithotomy (mPCNL). METHODS: Data from 287 patients who underwent mPCNL were analyzed. Complications after mPCNL were classified using both the CCI and the Clavien–Dindo classification (CDC). Descriptive statistics and linear/logistic regression analyses detailed the association between clinical predictors and mPCNL outcomes. RESULTS: After mPCNL, 83 (28.9%) patients had complications, of which 12 (4.2%) patients with multiple complications had a higher CCI score compared to the traditional CDC system accounting only for the highest grade. The CCI enabled a more accurate prediction of length of stay (LOS) than CDC (CCI: r = 0.32; p < 0.01 vs. CDC: r = 0.26; p = 0.01). Patients with multiple complications had higher stone volume (p = 0.02), longer operative time and LOS (all p < 0.01). A higher rate of post-operative hospital readmission (33.3% vs. 9.9%, p = 0.02) and lower rate of stone free (33.3% vs. 64.7%, p = 0.04) were found in patients with multiple complications than in those with single complication. Linear regression analysis revealed that multiple complications were associated with longer LOS (p < 0.001) after accounting for BMI and stone volume. Similarly, having multiple complications was associated with fivefold higher risk of readmission (p = 0.02). CONCLUSION: The CCI is a valuable metric for assessing post-operative complications after mPCNL. The cumulative CCI is a better predictor of LOS than the CDC for mPCNL. Minor complications not captured by the highest CDC score are relevant since patients with multiple complications have longer LOS and higher rate of readmission than those with single ones. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00345-022-04045-9. Springer Berlin Heidelberg 2022-05-28 2022 /pmc/articles/PMC9236985/ /pubmed/35643945 http://dx.doi.org/10.1007/s00345-022-04045-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Boeri, Luca Turetti, Matteo Silvani, Carlo Fulgheri, Irene Jannello, Letizia Maria Ippolita Garbagnati, Susanna Malfatto, Matteo Galbiati, Gilda Pozzi, Efrem Zanetti, Stefano Paolo Longo, Fabrizio De Lorenzis, Elisa Albo, Giancarlo Salonia, Andrea Montanari, Emanuele The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind? |
title | The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind? |
title_full | The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind? |
title_fullStr | The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind? |
title_full_unstemmed | The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind? |
title_short | The comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the Clavien–Dindo classification behind? |
title_sort | comprehensive complication index as a tool for reporting the burden of complications after mini-percutaneous nephrolithotomy: is it time to leave the clavien–dindo classification behind? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9236985/ https://www.ncbi.nlm.nih.gov/pubmed/35643945 http://dx.doi.org/10.1007/s00345-022-04045-9 |
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