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Is it worth using the Comprehensive Complication Index over the Clavien-Dindo classification in elderly patients who

Alexandre Danilovic1, Gustavo Perrone2, Lucas Dias3

  • 1Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil. alexandre.danilovic@hc.fm.usp.br.

World Journal of Urology
|October 28, 2024
PubMed

Insights

The Comprehensive Complication Index (CCI) and Clavien-Dindo classification (CDC) similarly predict complications after percutaneous nephrolithotomy (PCNL) in elderly patients. However, CDC underestimates hospitalization costs compared to CCI.

Area of Science:

  • Urology
  • Surgical Outcomes
  • Geriatric Medicine

Background:

  • Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stones.
  • Assessing postoperative complications in elderly patients undergoing PCNL is crucial.
  • The Comprehensive Complication Index (CCI) and Clavien-Dindo classification (CDC) are used to grade surgical complications.

Purpose of the Study:

  • To compare the efficacy of CCI and CDC in evaluating complications after PCNL in elderly patients.
  • To identify predictors of postoperative complications in this specific demographic.
  • To analyze the correlation of these indices with length of stay and emergency room admissions.

Main Methods:

  • Retrospective cohort study of patients aged 60 years and older who underwent PCNL (2009-2020).
  • Postoperative complications were assessed within 30 days.
  • Both CDC and CCI were calculated; length of stay and emergency room admissions served as complication surrogates.

Main Results:

  • 244 elderly patients were included (median age 65).
  • 15.6% experienced postoperative complications, with 2.5% having multiple.
  • Both CDC and CCI correlated significantly with length of stay and ER admissions.
  • CDC underestimated hospitalization costs compared to CCI (p=0.049).
  • Higher ASA physical status, Charlson Comorbidity Index, Guy's classification, and UTI history predicted complications.

Conclusions:

  • CDC and CCI demonstrate comparable correlation with length of stay and ER admissions post-PCNL in the elderly.
  • CCI provides a more comprehensive assessment of hospitalization costs than CDC.
  • Elevated ASA physical status, Charlson Comorbidity Index, Guy's classification, and prior UTI are significant predictors of complications in this population.
Abstract

Keywords:
ElderlyKidney stonesPercutaneous nephrolithotomyPostoperative complicationsUrolithiasis

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