Comparison of two indices to annotate complications after radical nephroureterectomy

Introduction: The Clavien-Dindo (CD) and ComprehensiveComplication Index (CCI) are two grading systems thatannotate adverse events following surgical procedures.We compare these two classification systems in a cohort ofpatients undergoing radical nephroureterectomy (RNU).Materials and methods: The charts of 110 consecutiveRNU patients were reviewed for complications occurringwithin 30 days of surgery. Grading by the CDclassification system and values for CCI were calculated.Bivariate and multivariate analysis identified associationsbetween perioperative variables and complications, as wellas relationship to hospital length of stay.Results: Sixty-seven men and 43 women with a medianage of 71, body mass index of 29, estimated glomerularfiltration rate (eGFR) of 64 mL/min/1.73 m2, and Charlsonscore of 4 were included. Seventy-five percent underwenta minimally invasive RNU, 47% had a lymph nodedissection, and 7% received neoadjuvant chemotherapy.Median hospital length of stay was 4 days (range, 2-22).Overall, 39 patients (35%) experienced a total of 56complications including 12 major (= Clavien III) and 44minor. Median CCI patients with complications cohort was20.9 (range, 8.7-100). The upper quartile of CCI (> 75th %)was associated with higher Charlson score (p = 0.03), lowerbaseline eGFR (p = 0.005), intraoperative transfusion(p = 0.004), and absence of symptoms at presentation(p = 0.015). Major CD complications were associatedwith these same variables. On multivariate analysis, onlythe upper quartile of CCI was associated with length ofstay (8.25 versus 5.61 days, p < 0.0001) whilst major CDcomplications were not (7.98 versus 6.32, p = 0.211).Conclusions: The CCI and CD classification schemesare both associated with similar baseline and perioperativecharacteristics for RNU patients. However, the cumulativenature of CCI appears to permit more accurate prediction oflength of stay following surgery compared to the CD system.