Chronic pulmonary diseases are independent risk factors for complications after radical nephrectomy

We aimed to identify the prognostic factors and the new parameters such as Charlson's comorbidity index (CCI) that might predict postoperative complication rates in a radical nephrectomy cohort. We also evaluated the correlation of CCI with the Clavien postoperative complication scale (CPCS).

Perioperative characteristics of 47 patients undergoing radical nephrectomy were recorded. Following items were assessed: preoperative patient characteristics including age, gender, CCI, American Society of Anesthesiologists (ASA) physical status classification system category, renal and hepatic functions, type of nephrectomy incision, operative time, clinical stage and histopathological subtype of the tumor, and preoperative co-morbid conditions including diabetes mellitus, hypertension, chronic pulmonary disease, peptic ulcers, renal and hepatic dysfunction. Postoperative complications were defined as death, wound infection, pneumonia, atelectasis, pulmonary emboli, anemia, sepsis, cardiac arrhythmia, myocardial infarction, and deep vein thrombosis. In addition, postoperative complications were also graded according to the CPCS and accepted as those occurring within 30 days.

Preoperative chronic pulmonary diseases were found to be significant risk factors for the development of postoperative complications. Age adjusted odds ratio was 7.112 for chronic pulmonary disease. The mean CCI in patients who did not develop any postoperative complication was 4.49 ± 1.95, whereas it was 5.75 ± 2.60 for patients who developed postoperative complications (P = 0.138). In Spearman correlation analysis, CCI value was found to be significantly correlated with CPCS grade (P = 0.011, rho value = 0.366).

Presence of chronic pulmonary disease is a strong predictor of postoperative complications after radical nephrectomy. Patients with higher preoperative CCI scores may have higher postoperative CPCS grades. Additional studies are warranted.