Tumor nephrectomy and radical prostatectomy Clavien-Dindo complication report

Šimunović Dalibor, Sudarević Bojan, Kuveždić Hrvoje,

Department of Urology, University Hospital Center Osijek, Osijek, Croatia

Complications are expected at various rate and grade after surgical procedure. Rate and grade of complications are different for every procedure. Surgical complication are dependent on procedure type, patient risk and surgeon skill. Complex or novel procedures are associated with higher rate of complications. Higher rate of complications is noted in high risk patients and in surgeons with lower experience with procedure, best shown with “learning curve”. Reporting surgical complications should be mandatory, as such reports have lead to declining rate of complications for some procedures. Reporting complications is also useful tool in assessing best team or hospital for desired procedure. Clavien-Dindo (CD) modified complications report is most common method for reporting complications in urology and it’s use in recent years has grown exponentially.

CD has been used at our Department as of January 1st 2013 for 14 different major procedures, both open or endoscopic. Primary collection of data was done retrospectively and continued prospectively. CD report is filled by discharging physician and revised at 3 month follow-up visit by senior surgeon. Data is presented for 66 tumor nephrectomies (TNEF) and 22 radical prostatectomies (RP) done in 2013.

Average age of TNEF patients was 65 years. Patient risk was assessed with ASA score: ASA I 48%, II/III 15%, III 29%, III/IV 3% and ASA IV in 5%. T Stage was as follows: T1/T1a – 23%, T1b – 36%, T2 – 32%, T3 – 3% and T4 in 6%. CD grade was I in 55%, II in 32%, IIIa in 8% and IIIb in 5%. T stage stratified CD analysis showed that CD was not associated with T stage (p=0.322). Effect of surgeon experience (junior – 10 or less years as urologist, senior > 10 years) on overall CD distribution, CD I/II vs CD III/IV, CD distribution in T1 and T2 tumors showed no statistical significance (p=0.102, p=0.66, p=0.318), with seniors performing better in T2 tumors (p=0.08). RP was performed in 22 patients and CD was as: I in 23%, II in 50%, IIIa in 18%, IIIb in 9% and IV in 5%. There was no difference in complications for all three surgeons in regard to CD overall, CD with EAU risk assessment or T stage (p=0.27, p=0.473, p=0.421).

Even in short time our institutional analysis showed us some pointers at our surgical treatment of renal tumors and prostate cancer. Our complication rate is as cited and clear “learning curve” is visible for TNEF, as seniors outperform juniors in larger tumors (p=0.08). There is no difference in complication rate for three surgeons performing RP (1 senior and 2 juniors).