Categorisation of Complications and Validation of the Clavien Score for Percutaneous Nephrolithotomy

Rosette, Jean J.M.C.H. de la; Opondo, Dedan; Daels, Francisco Pedro Juan; Giusti, Guido; Serrano, Álvaro; Kandasami, Sangam V.; Wolf, J. Stuart; Grabe, Magnus; Gravas, Stavros

doi:10.1016/j.eururo.2012.03.055

Cited by 339 publications

(196 citation statements)

References 25 publications

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“…Recent studies have extended the use of the modified Clavien classification system to the assessment of outcomes of PCNL; and has been formally validated with categorization of PCNL specific complications. [12][13][14] We present the results of PCNL with the aim to determine the preoperative and perioperative prognostic factors of complications associated with PCNL.…”

Section: 47-10mentioning

confidence: 99%

Risk Factors for Postoperative Complications after Percutaneous Nephrolithotomy

Basnet

Shrestha

et al. 2018

J Nepal Health Res Council

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Background:To identify the perioperative factors associated with complications after percutaneous nephrolithotomy by classification of complications according to the modified Clavien scoring system and evaluation of the minor and major complications related to the procedure. Methods:A prospective study of all the percutaneous nephrolithotomy performed by standard technique within 1.5 years at Bir Hospital was made. Possible demographic, preoperative and intraoperative variables were included in the study and patients were followed up postoperatively for any complications. All complications were classified according to modified Clavien scoring system and analyzed to identify the prognostic variables.Results: Two hundred and forty six percutaneous nephrolithotomy done within the study period were analyzed. Although 41.06 % of the study population developed complications, only 9.35 % had major complications. Age, body mass index, gender, clinical presentation, history of previous surgery and ASA score did not correlate with complications. Diabetes was the only comorbidity associated (p = 0.0482). Preoperatively estimated stone burden (p = 0.0023), number of calyces involved by the stones (p = 0.0002), and presence of staghorn calculi were significantly associated with development of postoperative complications. Multiple tracts were required (p = 0.0151) and operative time was longer (p < 0001) in the patients who developed complications. Conclusions:Percutaneous nephrolithotomy has lesser complications. Diabetic patients are more prone to develop complications. Larger stone burden, involvement of multiple calyces by stones and staghorn calculi are associated with need of multiple tracts and longer operative time, thus predisposing to higher incidence of complications.

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Section: 47-10mentioning

confidence: 99%

Risk Factors for Postoperative Complications after Percutaneous Nephrolithotomy

Basnet

Shrestha

et al. 2018

J Nepal Health Res Council

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“…[1][2][3][4][5][6][7][8]10,12 Compared with others studies, we had comparative results about complete supine PCNL complications according to the MCC. [3][4][5][6][7][8]10,12,[15][16][17] The types of complications, their management, and outcomes affect this classification. 9,12 Therefore the MCC can be used to evaluate the severity of complications, yet it has its limitations.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8]10,12,[15][16][17] The types of complications, their management, and outcomes affect this classification. 9,12 Therefore the MCC can be used to evaluate the severity of complications, yet it has its limitations. The MCC cannot predict the occurrence of a specific complication and cannot reveal its reason.…”

Section: Discussionmentioning

confidence: 99%

“…If a single standardized manner is used for reporting and managing complications, the MCC can be applied to assess and compare PCNL complications at different centers or with techniques. 12,18,19 Improvement in the management of complications and detection of the factors affecting MCC can influence the severity of complications. Age, gender, BMI, hypertension, DM, cardiovascular disease, previous kidney or stone treatment and surgery, prior ESWL, preoperative hematocrit and kidney side had no significant effect on the mean Clavien score, risk of grade ≥IIIa, major complications or complication rate.…”

Section: Discussionmentioning

confidence: 99%

“…9 In recent years, this classification has been used to report PCNL complications instead of using simply "minor" and "major" distinctions. [3][4][5][6][7][8][10][11][12] In this study, we reported on the PCNL complications according to the MCC and identified the parameters affecting the severity of complications based on this classification. …”

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Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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Cite as: Can Urol Assoc J 2015;9(1-2):e83-92. http://dx.doi.org/10.5489/cuaj.2248 Published online February 9, 2015. AbstractIntroduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC. IntroductionPresently, percutaneous nephrolithotomy (PCNL) is preferred as a safe and effective way to remove large or multiple upper urinary tract calculi. [1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.1,2,4,5 Following PCNL, 79.5% of patients may experience an uncomplicated postoperative period, 5,8 although there are reports of an early complication rate of 50.8%. 4PCNL complications may occur during puncturing, access, or stone removal. 4 A standardized classification allow us to compare complications among different instruments, te...

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