73 PATIENT COMORBIDITY STRATIFIED BY CHARLSON INDEX IS PREDICTIVE OF MEDICAL COMPLICATIONS FOLLOWING PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-Based Medicine & Outcomes (II)1 Apr 201373 PATIENT COMORBIDITY STRATIFIED BY CHARLSON INDEX IS PREDICTIVE OF MEDICAL COMPLICATIONS FOLLOWING PARTIAL NEPHRECTOMY Jay Simhan, Marc Smaldone, Kevin Tsai, Tianyu Li, Daniel Canter, Anthony Corcoran, Serge Ginzburg, Steven Sterious, Zachary Piotrowski, Rosalia Viterbo, David Chen, Richard Greenberg, Alexander Kutikov, and Robert Uzzo Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Kevin TsaiKevin Tsai Philadelphia, PA More articles by this author , Tianyu LiTianyu Li Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Philadelphia, PA More articles by this author , Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Serge GinzburgSerge Ginzburg Philadelphia, PA More articles by this author , Steven SteriousSteven Sterious Philadelphia, PA More articles by this author , Zachary PiotrowskiZachary Piotrowski Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , and Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1451AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of comorbidity on adverse events following partial nephrectomy (PN) is poorly characterized. Our objective was to assess the association between patient comorbidity stratified by Charlson Comorbidity Index (CCI) and complication rates following PN. METHODS We queried our prospectively maintained institutional kidney cancer database for all patients undergoing PN from 2007-2011. Postoperative complications within 30 days of PN, determined using the Clavien-Dindo classification system (CCS), were classified as medical or surgical in type and further stratified by minor (CCS I-II) and major (III-V) severity. Patient and tumor characteristics were compared between complication groups using Wilcoxon and Chi-square tests. The relationship between CCI and any complication, medical/surgical complications, and medical/surgical complications stratified by severity were assessed using logistic regression analyses controlling for age, race, gender, CCI, body mass index, estimated blood loss (EBL), ECOG score, ASA score, nephrometry score (NS), operative time, and surgical approach. RESULTS 512 patients (median age 59yrs, 64.3% male) underwent PN (median NS 8.0, median tumor size 3.0cm) with median follow-up of 23 months (range 5-48mo). All patients were stratified into cohorts developing any complication (35.2%), any medical (18.4%)/surgical (23.4%) complication, and patients sustaining major/minor medical (2.5%/16.8%) or surgical (8.8%/17.6%) complications after surgery. Compared to patients with no complications, those who incurred any complication tended to have greater NS (p<0.001), ASA score (p<0.005), EBL (p<0.001), operative time (p<0.001), and preoperative tumor size (p<0.001). Controlling for patient and clinical characteristics, increasing CCI was associated with the development of any complication (OR 1.11, CI 1.01-1.21), any medical complication (OR 1.14, CI 1.01-1.28), and any major medical complication (OR 1.66, CI 1.25-2.21) following PN. In contrast, no associations between CCI and surgical complications (in aggregate or stratified by severity) were demonstrated. CONCLUSIONS In our cohort, increasing Charlson Comorbidity Index is an independent predictor of the development of any Clavien graded medical complication and any major medical complication following PN. This association should be objectified in published reports and integrated into the decision-making and counseling of patients with competing medical risks that present with localized renal tumors. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e30 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Simhan Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Kevin Tsai Philadelphia, PA More articles by this author Tianyu Li Philadelphia, PA More articles by this author Daniel Canter Philadelphia, PA More articles by this author Anthony Corcoran Philadelphia, PA More articles by this author Serge Ginzburg Philadelphia, PA More articles by this author Steven Sterious Philadelphia, PA More articles by this author Zachary Piotrowski Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...