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Assessment of Clavien-Dindo classification in patients >75 years undergoing nephrectomy/nephroureterectomy.

Khan A, Palit V, Myatt A, Cartledge JJ, Browning AJ, Joyce AD, Biyani CS - Urol Ann (2013)

Bottom Line: Studies show satisfactory survival and oncological outcomes albeit with a slight increase in post-operative morbidity compared to younger patients.No significant difference was noted in the 2 groups.We believe that in elderly patients, laparoscopic surgery can be offered safely without significantly increasing the surgical risks.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, St James's University Hospital, Leeds, United Kingdom.

ABSTRACT

Introduction: There is a paucity of a standardized post-operative complications grading system in urology especially in the elderly population. Studies show satisfactory survival and oncological outcomes albeit with a slight increase in post-operative morbidity compared to younger patients. The Clavien-Dindo classification for post-operative complications is established as a valid system worldwide and applicable in many fields of surgery.

Purpose: Retrospective assessment of post-operative complications in patients >75 years who underwent open/laparoscopic nephrectomy/nephroureterectomy for renal diseases and grading the post-operative complications according to the Clavien-Dindo classification.

Materials and methods: Retrospective review of case notes was performed in patients >75 years who underwent a laparoscopic/open nephrectomy/nephroureterectomy between 2000 and 2008. Post-operative complications were graded according to the Clavien-Dindo classification.

Results: A total of 54 patients >75 years underwent nephrectomy/nephroureterectomy. 29 patients had laparoscopy and 25 had open surgery. Fifty one patients had a malignancy and 3 had benign diseases. Grade I, II, IIIa, IIIb and IVa were 25.6%, 41.1%, 7.7%, 7.7% and 17.9% respectively. No significant difference was noted in the 2 groups.

Conclusions: We believe that in elderly patients, laparoscopic surgery can be offered safely without significantly increasing the surgical risks. The Clavien-Dindo classification is easy to use and effectively applied to categorize post-operative complications associated with nephrectomy/nephroureterectomy in elderly population. However, this system needs slight modification to incorporate intra-operative complications and large studies are needed to validate and standardize this classification for all urological procedures.

No MeSH data available.


Related in: MedlinePlus

BMI and complications in laparoscopic and open groups combined
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Related In: Results  -  Collection

License
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Figure 2: BMI and complications in laparoscopic and open groups combined

Mentions: The complications are outlined in Table 3 with their respective P values and confidence intervals. As a secondary observation statistical analysis comparing post-operative complications in both groups according to the Clavien-Dindo system showed no extra risks in the laparoscopic group compared to the open group in octogenarians. The study also showed a higher T stage of the disease was associated with a significantly higher complication rate with T3 accounting for 44.7% of all complications [Figure 1]. Similarly, patients with a high BMI accounted for most of the complications in the two groups. A BMI >24.5 resulted in 50% of the overall complications in the two groups [Figure 2].


Assessment of Clavien-Dindo classification in patients >75 years undergoing nephrectomy/nephroureterectomy.

Khan A, Palit V, Myatt A, Cartledge JJ, Browning AJ, Joyce AD, Biyani CS - Urol Ann (2013)

BMI and complications in laparoscopic and open groups combined
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643316&req=5

Figure 2: BMI and complications in laparoscopic and open groups combined
Mentions: The complications are outlined in Table 3 with their respective P values and confidence intervals. As a secondary observation statistical analysis comparing post-operative complications in both groups according to the Clavien-Dindo system showed no extra risks in the laparoscopic group compared to the open group in octogenarians. The study also showed a higher T stage of the disease was associated with a significantly higher complication rate with T3 accounting for 44.7% of all complications [Figure 1]. Similarly, patients with a high BMI accounted for most of the complications in the two groups. A BMI >24.5 resulted in 50% of the overall complications in the two groups [Figure 2].

Bottom Line: Studies show satisfactory survival and oncological outcomes albeit with a slight increase in post-operative morbidity compared to younger patients.No significant difference was noted in the 2 groups.We believe that in elderly patients, laparoscopic surgery can be offered safely without significantly increasing the surgical risks.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, St James's University Hospital, Leeds, United Kingdom.

ABSTRACT

Introduction: There is a paucity of a standardized post-operative complications grading system in urology especially in the elderly population. Studies show satisfactory survival and oncological outcomes albeit with a slight increase in post-operative morbidity compared to younger patients. The Clavien-Dindo classification for post-operative complications is established as a valid system worldwide and applicable in many fields of surgery.

Purpose: Retrospective assessment of post-operative complications in patients >75 years who underwent open/laparoscopic nephrectomy/nephroureterectomy for renal diseases and grading the post-operative complications according to the Clavien-Dindo classification.

Materials and methods: Retrospective review of case notes was performed in patients >75 years who underwent a laparoscopic/open nephrectomy/nephroureterectomy between 2000 and 2008. Post-operative complications were graded according to the Clavien-Dindo classification.

Results: A total of 54 patients >75 years underwent nephrectomy/nephroureterectomy. 29 patients had laparoscopy and 25 had open surgery. Fifty one patients had a malignancy and 3 had benign diseases. Grade I, II, IIIa, IIIb and IVa were 25.6%, 41.1%, 7.7%, 7.7% and 17.9% respectively. No significant difference was noted in the 2 groups.

Conclusions: We believe that in elderly patients, laparoscopic surgery can be offered safely without significantly increasing the surgical risks. The Clavien-Dindo classification is easy to use and effectively applied to categorize post-operative complications associated with nephrectomy/nephroureterectomy in elderly population. However, this system needs slight modification to incorporate intra-operative complications and large studies are needed to validate and standardize this classification for all urological procedures.

No MeSH data available.


Related in: MedlinePlus