Clavien Classification Of Surgical Complications Research Articles

Clavien Classification of Complication of Surgery in Emergency Laparotomy: A Study of 40 Cases in Combined Military Hospital.

Introduction: Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers, therapies and over time.
 Objective: Objective of the study was to assess the Clavien classification of surgical complications of patients who underwent emergency laparotomy.
 Materials and Methods: The classification was tested on 40 patients who underwent emergency laparotomy in various Combined Military Hospitals (CMH) over a period of 09 years. Data recorded including demographics, clinical presentations, operating techniques, incision, post-operative complications and the duration of hospital stay.
 Results: Out of the total 40 patients, 28(70%) were male and 12(30%) female. Male: Female ratio was 2.33:1. A total of 29(72.50%) patients experienced postoperative complications. More than one complications occurred in 14(35%) patients. There were 13(32.50%) patients in the Clavien grade-I category, 09(22.50%) patients were classified as grade-II and grade-IIIa, 05(12.50%) patients had IIIb complications, grade-IVb and V complications occurred in 03(07.50%) patients each. The mean length of hospital stay was 15.28 days.
 Conclusion: This classification seems to be applicable in most parts of the world and may even be used by surgeons who are less experienced. In addition, standardization of postoperative care is essential to minimize postoperative complications.
 Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 7-13

Prospective Randomized Comparison of Transperitoneal vs Retroperitoneal Laparoscopic Simple Nephrectomy

To compare the results of transperitoneal laparoscopic vs retroperitoneoscopic simple nephrectomy for benign renal diseases in a prospective randomized design. In this study between January 2009 and August 2013, 31 patients underwent transperitoneal laparoscopic nephrectomy and 31 retroperitoneoscopic nephrectomy after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Secondary objectives were to compare each of the operative techniques in terms of duration of surgery, complication rates, and postoperative convalescence. Statistical analysis was performed with SPSS version 16.0 with P<.05 considered statistically significant. The difference in the visual pain score (4.9 vs 2.7 on day 1; 3.2 vs 1.1 on day 2) and the tramadol requirements (167.3 vs 132.8mg) were statistically significant and more in the transperitoneal laparoscopic nephrectomy. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Three patients in transperitoneal laparoscopic nephrectomy group and 2 patients in retroperitoneoscopic group required conversion. Mean time to normal activities wassignificantly less in retroperitoneal laparoscopic nephrectomy group (16.7±3.5 vs 9.34±4.9days; P=.0001). Although both transperitoneal laparoscopic and retroperitoneoscopic simple nephrectomy are feasible options for nonfunctioning kidneys due to benign renal diseases in adults, retroperitoneal laparoscopic nephrectomy is associated with significantly less pain, less analgesic requirement, shorter hospital stay, and short convalescence as compared with transperitoneal laparoscopic approach.

MP3-20 RENAL AUTOTRANSPLANTATION: AN UNDERUTILIZED OPERATION FOR COMPLEX UPPER TRACT PATHOLOGY

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 2014MP3-20 RENAL AUTOTRANSPLANTATION: AN UNDERUTILIZED OPERATION FOR COMPLEX UPPER TRACT PATHOLOGY Nikolai Sopko, Alvin Wee, John Rabets, Hannah Kerr, Stuart Flechner, and Vankatesh Krishnamurthi Nikolai SopkoNikolai Sopko More articles by this author , Alvin WeeAlvin Wee More articles by this author , John RabetsJohn Rabets More articles by this author , Hannah KerrHannah Kerr More articles by this author , Stuart FlechnerStuart Flechner More articles by this author , and Vankatesh KrishnamurthiVankatesh Krishnamurthi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.199AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Review of current indications and treatment success of renal autotransplantation in patients with high rates of failed treatments and prior abdominal surgeries. METHODS We performed an IRB approved retrospective review of all patients who underwent renal autotransplantation at our institution, between January 2005 and August 2013. Complications were graded according to the Clavien Classification of Surgical Complications. RESULTS 61 patients underwent renal autotransplantation of 63 renal units (2 patients underwent bilateral autotransplantation). Indications included medical stone disease that was refractory to endoscopic management 23 (37%), proximal ureteral obstruction 18 (29%), renovascular disease 17 (27%), and loin pain-hematuria syndrome (LPHS) 5 (9%). Forty patients (63%) had prior open abdominal surgery with 16 (25%) having 3 or more operations. Median ASA score was 2 with 40% of patients with a score of 3. Operative approaches included a single midline intraperitoneal incision in 44 patients (70%), separate extraperitoneal (flank and lower quadrant) incisions in 17 patients (27%) and laparoscopic nephrectomy followed by an extraperitoneal lower quadrant incision in 2 patients (3%). Mean autograft nephrectomy time was 152 ± 79 minutes. Mean vascular anastomosis time was 50 ± 21 minutes. Median follow-up was 7 (IQR 2-23) months. Immediate technical success was achieved in 62 patients (98%). 2 grafts (3%), transplanted for stone disease and a proximal ureteral obstruction, failed and were removed on post-operative days 0 and 2, respectively. Resolution of the primary indication was noted in 53 (84%) patients. Chronic pain was associated with a worse outcome. Of the failed treatments, 2 had LPHS and 4 had stone disease with refractory pain despite resolution of obstruction. Median hospital stay was 8 (IQR 7-10) days with 2 readmissions within 30 days of discharge. 12 patients (19%) had Clavien Grade II, 2 (3%) had Clavien Grade III, and 1 had a Clavien Grade IV surgical complication. There were no deaths. All postoperative complications resolved without autograft compromise. CONCLUSIONS Renal autotransplantation can provide excellent outcomes for difficult to treat urologic and vascular conditions in a complex patient population. Utilization of 2 extraperitoneal incisions aids in cases of multiple prior abdominal surgeries and facilitates decreased nephrectomy and vascular anastomosis times. Patients undergoing autotransplantation for chronic pain have a greater chance of continued symptoms however the majority have resolution. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e41-e42 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nikolai Sopko More articles by this author Alvin Wee More articles by this author John Rabets More articles by this author Hannah Kerr More articles by this author Stuart Flechner More articles by this author Vankatesh Krishnamurthi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bladder Neck Incision for Female Bladder Neck Obstruction: Long-term Outcomes

To evaluate the long-term outcomes of bladder neck incision (BNI) for primary bladder neck obstruction in women. Eighty-four women were diagnosed on the basis of videourodynamic study. BNI was performed for each patient, with incisions made at 2 different sites on the bladder neck. Follow-up data were available for 6-78 months (average, 27.4), postoperatively. Successful recovery after BNI without serious complications was achieved in 71 of 84 (84.5%) patients. During follow-up, the mean International Prostate Symptom Score decreased from 22.9 to 7.9 (P <.01). Quality of life decreased from 4.1 to 2.4 (P <.01). The maximum uroflow rate increased from 9.75 to 18.79 mL/s (P <.01). The postvoid residual decreased from 115.11 to 23.29 mL (P <.01). The maximal detrusor pressure at the maximum uroflow rate decreased from 69.61 to 20.48 cm H2O (P <.01). Several complications were identified after surgery, including hemorrhage, re-BNI, vesicovaginal fistula (VVF), stress urinary incontinence (SUI), and urethral stricture. All these complications were grade IIIa in the Clavien Classification of Surgical Complications. Three patients (3.6%) developed a VVF after BNI; these VVFs were repaired successfully. Four (4.7%) patients experienced SUI and recovered after transvaginal tension-free vaginal tape-obturator. Postoperative bleeding was identified in 3 patients (3.6%), and 1 received a blood transfusion. Three (3.6%) patients experienced urethral stricture after BNI and recovered after receiving intermittent urethral dilation. Primary bladder neck obstruction is uncommon and easily treatable when properly diagnosed by videourodynamic study, and BNI has a high success rate. Careful, sufficiently deep incisions at the 2- and 10-o'clock positions can ensure its success. Complications such as postoperative VVF or SUI can occur and must be actively managed.

Prospective Randomized Comparison of Retroperitoneoscopic vs Open Pyeloplasty With Minimal Incision: Subjective and Objective Assessment in Adults

To determine the subjective and objective outcomes of retroperitoneoscopic vs open pyeloplasty with minimal incision in a prospective randomized comparison study. In this study between August 2011 to July 2013, 30 patients underwent retroperitoneal laparoscopic pyeloplasty and 30 open pyeloplasty with minimal incision (incision length <10 cm) after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Success rates were evaluated by improvement in pain score and objectively by diethylene triamine penta-acetic acid renal scan and other parameters. Statistical analysis was performed with SPSS version 16.0 (IBM) with P <.05 considered statistically significant. The difference in the visual pain score (5.6 vs 3.2 on day 1; 3.8 vs 1.5 on day 2) and the diclofenac requirements (333.3 vs 178.75 mg) were statistically significant and more in the open pyeloplasty. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Success rate was found to be 96.67% with 1 failure in each group. Two patients in retroperitoneoscopic group required conversion. Both groups showed significant improvement in pain score and drainage pattern on diethylene triamine penta-acetic acid scan with decrease in hydronephrosis on ultrasound evaluation. Although subjective and objective outcomes are equivalent in both the groups, the retroperitoneoscopic approach is associated with significantly less pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison with open pyeloplasty.

Surgical risk and postoperative complications in the elderly aged 80years or more in cancer surgery

Introduction: Two thirds of solid tumors are diagnosed in the elderly and the largest number of cancer-related deaths is mostly seen in this group. However, there is sufficient evidence that the elderly, especially those aged 80 or more, frequently do not receive potentially curative surgical treatmentwhen compared to younger patients. It was observed in recent revisions that postoperative complications and survival in cancer surgery are age independent, and that a comprehensive geriatric assessment can be a reliable predictor of mortality in this population. Objectives: To describe the population aged 80 years or more who underwent oncological surgery in Cancer Institute of Sao Paulo (ICESP) and evaluate the surgical risk and postoperative complications in this population. Methods:Cross-sectional study,which analyzed the characteristics of the preoperative assessment of patients aged 80 years ormorewho received elective cancer surgery with general anesthesia, spinal anesthesia or sedation in 2011. The primary outcome was postoperative morbidity assessed by the presence of complications (grades II to V of Clavien Classification of Surgical Complications) and length of hospital stay. The chi-square test was used for comparison of categorical variables. To compare means were used the Mann-Whitney and Kruskal-Wallis Tests. To determine the factors associated with morbidity, characterized by the presence of complications and length of hospital stay, we used stepwise backward logistic and linear regression, respectively. Results: In 2011, 138 elective oncological surgeries were performed in patients aged 80 years ormore in ICESP. Themean agewas 84.2 (±4,2) years and 52% were female. Patients received the following surgical procedures: dermatological (29%), intraperitoneally (22%), endoscopy (18%), breast (10%), head and neck (9%), orchiectomy (9%), neurosurgery (2%) and orthopedic (1%). General anesthesia was performed in 67% of the elderly. 67% of the patients were classified as ASA II, 72% had a performance status less than 4 METS. The mean length hospital stay was 4.97 days (median 1,9). Postoperative complications were seen in 25% of patients. The mortality rate was 2% and rehospitalization occurred in 2% of cases. After multivariate analysis the following factors were foundwith p b 0.05 for the outcome complication: type of surgical procedure, surgery duration, functional status (METS) and creatinine clearance. For the outcome hospital stay, we found p b 0.05 for: surgery duration, hemoglobin and sex. Age was not seen as an isolated risk factor for postoperative complication. Conclusion: Cancer surgery in patients aged 80 or more is feasible and can provide low complication rate if patients are properly selected in a preoperative geriatric assessment.

Impact of comorbidity on complications after nephrectomy: use of the Clavien Classification of Surgical Complications

What's known on the subject? and What does the study add? Tumour characteristics, physical status and comorbidities are considered important for surgical outcome and prognosis. The present study objectively evaluates the association between comorbidity and postoperative complications after nephrectomy for RCC, by using the modified Clavien Classification of Surgical Complications to grade complications after nephrectomy. To present a single-centre experience of open nephrectomy for lesions suspected for renal cell carcinoma (RCC), evaluating the association between comorbidity and postoperative complications using a standardized classification system for postoperative complications. Clinicopathological data of 198 patients undergoing open radical or partial nephrectomy for lesions suspected of RCC were retrospectively analysed. Comorbidity scored by the Charlson comorbidity index (CCI), body mass index, age, gender, surgical procedure and surgical history were examined as predictive factors for postoperative complications, which were scored using the modified Clavien Classification of Surgical Complications (CCSC). The overall complication rate was 34%: 7% grade I, 15% grade II, 5% grade III, 3% grade IV and 4% grade V. Preoperative comorbidities were present in 51% of all patients. There were significantly more major complications (CCSC >2) in patients with major comorbidities (CCI >2), at 16% vs 7% (P = 0.018). Patients with high-stage RCC had significantly more severe complications than low-stage RCC (P = 0.018). In multivariable analysis, comorbidity (odds ratio [OR] 7.55, P = 0.004) and tumour stage 3-4 (OR 6.23, P = 0.007) were independent predictive factors for major complications. Major complications occur significantly more often when major comorbidities are present. Comorbidity scores can be used in risk stratification for complications and should be considered during decision-making and counselling of patients before nephrectomy.

Clavien Classification of Complications After 150 Laparoscopic Pyeloplasties

To compare the complications of laparoscopic pyeloplasty observed in 3 periods of our learning curve using the Clavien classification. We reviewed and retrospectively analyzed the records of 150 cases of laparoscopic pyeloplasty performed for primary ureteropelvic junction obstruction at our center. All patients were divided into 3 groups according to the order of the case number (1-50, 51-100, 101-150) to compare the intergroup differences in the preoperative data and perioperative parameters. The postoperative complications were subdivided according to the 5-grade Clavien classification of surgical complications. The groups of patients with and without complications were compared with respect to age, degree of hydronephrosis, positive urine culture before surgery, concomitant nephrolithiasis, crossing vessel, and the type of operation performed (dismembered vs nondismembered). The success rate was 90.5%. The mean follow-up was 53.7 months (range 5-103). Intraoperative complications occurred in 9 (6%) of 150 patients and postoperative complications in 27 (18%) of 150 patients. No statistically significant differences were seen between the incidence of intra- and postoperative complications among the compared groups. The only statistically significant difference among the groups with and without complications was the presence of a positive urine culture (19% vs 6%, respectively). The most common complications were connected with stent obstruction, and they did not seem dependent on surgeon experience. Patients with a preoperative positive urine culture might have a greater risk of postoperative complications.

1479 COMPLICATIONS OF RENAL CRYOABLATION: A SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 20101479 COMPLICATIONS OF RENAL CRYOABLATION: A SINGLE CENTER EXPERIENCE Abhinav Sidana, Piyush Aggarwal, Wasim H. Chowdhury, Zhaoyong Feng, Christos S. Georgiades, Bruce J. Trock, and Ronald Rodriguez Abhinav SidanaAbhinav Sidana More articles by this author , Piyush AggarwalPiyush Aggarwal More articles by this author , Wasim H. ChowdhuryWasim H. Chowdhury More articles by this author , Zhaoyong FengZhaoyong Feng More articles by this author , Christos S. GeorgiadesChristos S. Georgiades More articles by this author , Bruce J. TrockBruce J. Trock More articles by this author , and Ronald RodriguezRonald Rodriguez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1195AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cryoablation serves as a promising nephron-sparing alternative to partial nephrectomy for treatment of small renal masses.We hereby describe peri-operative complications associated with renal cryoablation and identify potential risk factors for certain complications. METHODS Retrospective analysis of the medical records of patients with unifocal renal masses treated by cryosurgery at a single center, between 1997 and 2007, was conducted. All complications associated with these procedures were documented and classified into grades 1 to 5 according to Clavien Classification of Surgical complications. An in-depth analysis was done to identify potential risk factors. RESULTS 162 (101 percutaneous, 52 laparoscopic and 9 open) procedures were evaluated. Complications were reported in 38 (23.5%) procedures, out of which 19 (11.7%) had only Grade 1, 8 (4.9%) had Grade 2, 5 (3.1%) had grade 3, and 6 (3.7%) had Grade 4 as the most severe complication. The most common complication was flank pain seen in 11 procedures, followed by perinephric hematoma and cardiovascular complications seen in 10 procedures each. Mass size (OR=3.52, 95%CI 1.69-7.36, p=0.001), number of probes used for cryoablation (OR=3.98, 95%CI 1.94-8.18, p<0.001) and chronic-anticoagulation (OR= 5.29, 95%CI 1.36-20.67, p=0.016) were associated with increased incidence of significant hematoma. In multivariable logistic regression, the total number of probes was the only significant predictor for hematoma occurrence (p<0.001). To determine a potential binary cut-off for mass size or number of probes as predictors of hematoma we performed Receiver operator characteristic analysis. The risk for bleeding is maximum for mass size greater than 3. 4 cm or when 3 or more probes are used simultaneously for cryoablation. Multivariable analyses of cardiovascular complications revealed that, both the open approach (OR=7.15, 95% CI 1.12-45.55, p=0.037) and lesion location in the upper pole (OR=5.62, 95% CI 1.36-23.18, p<0.017) were significant predictors of cardiac complications. Respiratory complications occurred in 7 (4.3%) of the patients. Patients with respiratory complications had significantly higher mean age (77.9 (8.8) vs 67.7 (11.9), p=0.025) and mean mass size (3.5 (1.4) vs 2.3 (0.9), p=0.014). CONCLUSIONS Cryoablation is a relatively safe procedure with low complications rates in properly selected patients. Here we identify potential risk factors which may help identify patients most at risk for certain complications and consequently assist in pre-procedural planning and counseling. Baltimore, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e570 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhinav Sidana More articles by this author Piyush Aggarwal More articles by this author Wasim H. Chowdhury More articles by this author Zhaoyong Feng More articles by this author Christos S. Georgiades More articles by this author Bruce J. Trock More articles by this author Ronald Rodriguez More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

An international conference of transplant physicians, surgeons, and allied health professionals was held in Vancouver, Canada, on September 15 and 16, 2005 to address the care of the live lung, liver, pancreas, and intestine organ donor. The Vancouver Forum was convened under the auspices of the Ethics Committee of The Transplantation Society. Forum participants included over 100 leaders in organ transplantation, representing many countries from around the world, including participants from the following continents: Africa, Asia, Australia, Europe, North and South America. The objective of the Vancouver Forum was to develop an international standard of care for the live lung, liver, pancreas and intestinal organ donor. This Vancouver Forum followed a conference convened in Amsterdam on the care of the live kidney donor (1, 2). There were four organ specific work groups at the Vancouver Forum: lung, liver, pancreas and intestine. Each organ work group addressed the following topics in concert and reported their findings in a plenary presentation to all participants: