You have accessJournal of UrologyBladder Cancer: Natural History & Pathophysiology1 Apr 2014MP50-04 A NOVEL METHOD OF STRATIFICATION OF COMPLICATION OF RADICAL CYSTECTOMY USING THE COMPREHENSIVE COMPLICATION INDEX Patrick N. Espiritu, Gautum Agarwal, Adam Luchey, Jorge L. Lockhart, Julio M. Pow-Sang, Philippe E. Spiess, Wade J. Sexton, and Michael A. Poch Patrick N. EspirituPatrick N. Espiritu More articles by this author , Gautum AgarwalGautum Agarwal More articles by this author , Adam LucheyAdam Luchey More articles by this author , Jorge L. LockhartJorge L. Lockhart More articles by this author , Julio M. Pow-SangJulio M. Pow-Sang More articles by this author , Philippe E. SpiessPhilippe E. Spiess More articles by this author , Wade J. SextonWade J. Sexton More articles by this author , and Michael A. PochMichael A. Poch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1125AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Radical cystectomy (RC) for urothelial carcinoma of the bladder is associated with significant perioperative morbidity. Traditional complication reporting methodology using the Clavien-Dindo system does not account for cumulative effects of complications. The Comprehensive Complication Index (CCI) is a recently described methodology to account for the cumulative affect of complications based on Clavien grade. The purpose of the study was to assess length of hospital stay in patients undergoing radical cystectomy following neoadjuvant chemotherapy using the CCI. Methods Using an IRB approved database a retrospective review of patients who received neoadjuvant chemotherapy followed by RC between 2001-2013 was evaluated to determine incidence of early complications. Using Martin criteria all complications within 30 days of surgery were identified and graded by the Clavien-Dindo system. Point values for complications were calculated as described by the CCI methodology. Chi-square and logistic regression analyses were performed to analyze relationships between preoperative covariates including age, gender, grade and stage of tumor, smoking status, Charlson Comorbidity Index, serum creatinine, BMI, American Society of Anesthesiologists Score, previous surgery, prior pelvic radiation, chemotherapy regimen with CCI. Results 165 patients met inclusion criteria for the study. Median age 67 years (IQR 59 - 74) and 45 patients (27%) were female. Ileal conduit diversion was performed in 117 patients (71%). Mean estimated blood loss was 996cc (SD 585cc). Median CCI score was 8.7 (IQR 8.7–22.6). Median hospital stay was 7 days (IQR 6 -9). The upper quartile of CCI was associated with male gender (p = 0.04), non-continent urinary diversion (p = 0.04), ≥4 units tansfused (p = 0.04), operative time (100 min, p = 0.01), and receipt of carboplatin based chemotherapy (p <0.01). When divided by quartiles, higher quartiles were associated with longer hospital stay (p = 0.02). When two or more Clavien grade II complications occurred in a single patient the CCI exceeded that of a single Clavien grade IIIa complication. When length of stay was compared there was no difference between the two groups (p = 0.08). Conclusions Complications after radical cystectomy have a compounding effect on outcome. Using the CCI the impact of complications based on severity and number may be a better predictor of length of stay. The compounding effect of multiple Clavien grade II complications can equal that of a high grade (Clavien grade ≥ IIIa) complication. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e495 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Patrick N. Espiritu More articles by this author Gautum Agarwal More articles by this author Adam Luchey More articles by this author Jorge L. Lockhart More articles by this author Julio M. Pow-Sang More articles by this author Philippe E. Spiess More articles by this author Wade J. Sexton More articles by this author Michael A. Poch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...