Preoperative Risk Factors Predicting Complication Rates of Augmentation Cystoplasty Using the Modified Clavien Classification System in Pediatric Population

Objectives: We aimed to evaluate the effect of American Society of Anesthesiology (ASA) classification scoring and age on complications and surgical outcomes during and after percutaneous nephrolithotomy (PCNL) operation. Material and methods: The records of 263 patients, above the age of 18 years, that underwent PCNL surgery between October 2014 and May 2017 were evaluated retrospectively. The patients were divided into three groups based on their ASA risk scores (ASA 1, 2, 3) and into two groups based on their age (younger and older than 65 years). Postoperative complications were assessed according to the ASA groups and age and according to the Clavien classification system. Results: The number of patients in the ASA 1, 2, and 3 groups were 97 (36.8%), 131 (49.8%) and 35 (13.3%), respectively. Four patients in ASA4 were not included in the study. There was no significant difference in ASA 1, 2, 3 groups in terms of changes in Hgb values, mean duration of operation, and mean hospital stay. When ASA1 was compared to ASA3 and ASA2 was compared to ASA3, there was no significant difference in the incidence of all complication rates. There were 159 (60.4%) patients in the young group and 104 (39.5%) patients in the elderly group. Postoperative PCNL complications of these 2 groups were compared according to Clavien classification system and no significant difference was found in incidence of complications.Conclusions: We believe that PCNL operation can be performed effectively and safely in both ASA3 patients and patients above the age of 65 years.

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Preoperative risk factors predicting postoperative complications in radical cystectomy for bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.395 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 395-395

Author(s):

Derek Jensen ◽

Stefan Graw ◽

Sida Niu ◽

Vassili Glazyrine ◽

Devin Koestler ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Bladder Cancer ◽

Postoperative Complications ◽

Prediction Model ◽

Radical Cystectomy ◽

Complication Rates ◽

Preoperative Risk ◽

Preoperative Risk Factors ◽

Risk Patients

395 Background: Radical cystectomy is an extensive operation with complications reported in up to 30.5% of patients. High complication rates contribute to increased costs, patient morbidity and mortality. Accurate prospective predictions of patients’ risk for post−surgical complications have the potential to identify at risk patients. Risk estimators have been developed but often involve an extensive number of factors or produce expansive results that are not clinically useful. Methods: 330 patients who underwent radical cystectomy for bladder cancer from January 2008 to July 2014 were included in this study. Potential preoperative risk predictors were collected from medical history, TURBT pathology, preoperative labs, proposed procedure type, and prior treatments. Postoperative complications were graded using the Clavien−Dindo scale. Multivariate logistic regression models were used to predict post−operative complications. Accuracy of prediction models was assessed using the area under the receiver operating characteristic curve. Results: Of the potential preoperative risk factors, 5, 10 and 16 unique predictors along with two way interactions were determined to have strong association with 90 day postoperative complications, yielding an AUC of 0.69, 0.79 and 0.91 respectively. Conclusions: Our findings suggest routinely collected preoperative patient−level clinical variables may be useful for determining patient risk for short−term postoperative complications. The flexibility in our prediction model for the number of predictor inputs allow users to tailor the degree of risk assessment based on a patient’s baseline heath status. A simple and accessible prediction model with selective predictors may help identify at risk patients for patient education, counseling and development of risk reduction strategies.

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