Introduction

Complication rates following radical nephroureterectomy (RNU) are reported to occur in 20-30% of patients. The Clavien-Dindo (CD) grading system is a well-known categorical classification of complication severity. The Comprehensive Complications Index (CCI) is an alternative grading system that aggregrates all complications experienced by a patient expressed on a continuous 0-100 scale. We investigate whether the cumulative nature of CCI renders it superior to CD in predicting perioperative course after RNU.

Methods

The records of 532 consecutive patents who underwent RNU at 7 academic medical centers between 2005-2015 were reviewed. Complications occurring within 30 days of RNU were annotated with grading both by the CD and CCI classification systems. Logistic regression was used to determined associations between CD and CCI with perioperative covariates as well as with hospital length of stay (LOS) and readmission.

Results

377 men and 219 women with a median age of 71, BMI of 27, and Charlson comorbidy score of 4 were included. 60% had an ASA score > 2, 22% were ECOG > 2, and 59% had baseline CKD stage III or greater. Approximately 75% underwent a minimally invasive RNU. Median LOS following RNU was 6.0 days (range, 1-37) and readmission within 30 days occurred in 45 (7%) 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 Charlson score, ECOG > 2, and CKD stage > III (p for all < 0.05). However, only the upper quartile of CCI was associated with LOS (8.9 vs. 5.4 days, p<0.01) and hospital readmission (OR 3.2, p =0.02) after RNU whilst major CD complications were not (LOS 7.4 vs. 5.6 days, p=0.14; Readmission OR 1.4, p=0.21)._x000D_

Conclusions

The CD and CCI classification systems both have their utility in evaluating baseline and perioperative characteristics for RNU patients. However, the continuous and cumulative nature of the CCI that accounts for complications severity appears to allow for superior prediction of perioperative course including LOS and readmission._x000D_

Funding

None