PD35-12 PREOPERATIVE FACTORS ASSOCIATED WITH COMPLICATIONS FOLLOWING RADICAL NEPHROURETERECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Tumors I1 Apr 2014PD35-12 PREOPERATIVE FACTORS ASSOCIATED WITH COMPLICATIONS FOLLOWING RADICAL NEPHROURETERECTOMY Kuan Lin, Erik Lehman, Laura-Maria Krabbe, Vitaly Margulis, Tobias Klatte, Shahrokh Shariat, Alex Arnouk, Costas Lallas, Edouard Trabulsi, Gregory Bozzini, Pierre Colin, Sarah Drouin, Morgan Roupret, Benoit Peyronnet, Karim Bensalah, Kari Bailey, David Canes, and Jay Raman Kuan LinKuan Lin More articles by this author , Erik LehmanErik Lehman More articles by this author , Laura-Maria KrabbeLaura-Maria Krabbe More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Tobias KlatteTobias Klatte More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Alex ArnoukAlex Arnouk More articles by this author , Costas LallasCostas Lallas More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Gregory BozziniGregory Bozzini More articles by this author , Pierre ColinPierre Colin More articles by this author , Sarah DrouinSarah Drouin More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Kari BaileyKari Bailey More articles by this author , David CanesDavid Canes More articles by this author , and Jay RamanJay Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2425AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical nephroureterectomy (RNU) is the gold standard for managing upper-tract urothelial carcinoma (UTUC). Perioperative complications may be significant given their impact on survival outcomes as well as potential delivery of adjuvant therapies when necessary. We review a multi-institutional, international cohort of patients undergoing RNU to define the incidence of perioperative complications as well as preoperative risk factors associated with these events. METHODS A retrospective review of institutional databases from 8 academic centers in the United States and Europe identified 732 patients who underwent RNU. Data on preoperative clinical, demographic, and comorbidity indices were collected. Complications occurring in these patients within 30-days of surgery were graded using the modified Clavien-Dindo scale. Univariate and multivariate analyses determined the association between preoperative variables and presence of complications. RESULTS 371 men and 361 women with median age of 70 years and BMI of 27 were included. Three-quarters of the cohort were Caucasian. Measurement of comorbidity indices noted median Charlson score of 4 (range, 1-14), while 44% had ASA ≥ 3 and 11% had ECOG status ≥ 2. Leading comorbid medical conditions included hypertension (55%), hyperlipidemia (41%), coronary artery disease (24%), diabetes (17%), and pulmonary disease (14%). Median baseline eGFR (CKD-EPI) was 58 ml/min/1.73m2 with 50% of the cohort having CKD stage ≥ III. Overall, 270 patients (37%) experienced a post-operative complication including 54 with Clavien III or greater events. On univariate analysis, patient age, race, baseline eGFR, comorbidities (diabetes, hyperlipidemia, hypertension) and all comorbidity indices (Charlson, ECOG, ASA) were associated with post-RNU complications. In a multivariate model including these variables, only patient age (OR 4.0, 95% CI 1.7 - 6.3, p=0.05), Charlson index (OR 4.5, 95% CI 2.1 - 6.8, p=0.03) and baseline eGFR (OR 7.8, 95% CI 3.4 - 12.1, p=0.005) were independently associated with post-operative complications. CONCLUSIONS Almost 40% of patients in our international cohort experienced a complication within 30 days of RNU. Increasing age, higher Charlson score, and lower baseline renal function were independently associated with patients developing complications. These metrics should be determined prior to surgery and may guide patient counseling and surgical expectations for the post-operative period. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e895 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Kuan Lin More articles by this author Erik Lehman More articles by this author Laura-Maria Krabbe More articles by this author Vitaly Margulis More articles by this author Tobias Klatte More articles by this author Shahrokh Shariat More articles by this author Alex Arnouk More articles by this author Costas Lallas More articles by this author Edouard Trabulsi More articles by this author Gregory Bozzini More articles by this author Pierre Colin More articles by this author Sarah Drouin More articles by this author Morgan Roupret More articles by this author Benoit Peyronnet More articles by this author Karim Bensalah More articles by this author Kari Bailey More articles by this author David Canes More articles by this author Jay Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...