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Published on: January 7, 2019
Preoperative Risk Factors Predicting Complication Rates of Augmentation Cystoplasty Using the Modified Clavien
Onur Telli1, Cihat Ozcan2, Nurullah Hamidi2
1Department of Paediatric Urology, School of Medicine, Ankara University, Ankara, Turkey.
Insights
Augmentation cystoplasty in children can lead to complications. Key predictors include Society of Fetal Urology grades 3-4 hydronephrosis, outlet resistance procedures, and elevated creatinine, guiding better surgical outcomes.
Area of Science:
- Pediatric Urology
- Surgical Complications
- Bladder Reconstruction
Background:
- Augmentation cystoplasty is a crucial procedure for managing severe bladder dysfunction in children.
- Standardized methods for evaluating postoperative complications are essential for assessing surgical outcomes.
Purpose of the Study:
- To identify preoperative factors predicting postoperative complications after augmentation cystoplasty in pediatric patients.
- To utilize the modified Clavien classification system (MCCS) for grading complications.
Main Methods:
- Retrospective review of 117 children undergoing augmentation cystoplasty (1994-2014).
- Complications were classified using the MCCS.
- Univariate and multivariate analyses were performed to identify predictive factors.
Main Results:
- Overall complication rate was 24.7% (29/117 children).
- Significant predictors identified via univariate analysis included antireflux surgery, outlet resistance procedures, SFU grades 3-4 hydronephrosis, posterior urethral valves, scoliosis, and serum creatinine > 1.0 mg/dL.
- Independent predictors in multivariate analysis were SFU grades 3-4 hydronephrosis, bladder neck reconstruction, and serum creatinine > 1.0 mg/dL.
Conclusions:
- Augmentation cystoplasty is an effective treatment for pediatric bladder dysfunction.
- Preoperative factors like SFU grades 3-4 hydronephrosis, outlet resistance procedures, and elevated creatinine predict complications.
- Standardized grading systems like MCCS facilitate comparable analysis of complication rates.
Objective:
To evaluate preoperative predictive factors for postoperative complications of augmentation cystoplasty in children by using the modified Clavien classification system (MCCS).
Patients And Methods:
A retrospective review of medical records between 1994 and 2014 identified 117 children (64 males and 53 females) who underwent augmentation cystoplasty. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates.
Results:
The mean (SD) age was 9.3 (1.9) years and the mean (SD) hospitalization time was 9.7 (3.6) days. Patients with an adverse or unexpected event within 30 days of surgery were identified. Complications occurred in 29 (24.7%) children; 13 (11.1%) were MCCS grade I, 8 (5.1%) were grade II, 5 (4.2%) were grade III, and 3 (2.5%) were grade IV. Antireflux surgery, outlet resistance increasing procedures, Society of Fetal Urology (SFU) grades 3-4 hydronephrosis, posterior urethral valves, scoliosis, and serum creatinine greater than 1.0 mg/dL were statistically significant predictors of complications on univariate analysis. In the multivariate analysis, SFU grades 3-4 hydronephrosis, bladder neck reconstruction, and serum creatinine greater than 1.0 mg/dL were statistically significant independent predictors of complications.
Conclusion:
Augmentation cystoplasty remains a valid method of treating severe bladder dysfunction in children. SFU grades 3-4 hydronephrosis, outlet resistance increasing procedures, and serum creatinine greater than 1.0 mg/dL were the main predictive factors for postoperative complications. Use of a standardized complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.
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