Comparison of two indices to annotate complications after radical nephroureterectomy.

Introduction: The Clavien-Dindo (CD) and Comprehensive Complication Index (CCI) are two grading systems that annotate adverse events following surgical procedures. We compare these two classification systems in a cohort of patients undergoing radical nephroureterectomy (RNU).
Materials and Methods: The charts of 110 consecutive RNU patients were reviewed for complications occurring within 30 days of surgery. Grading by the CD classification system and values for CCI were calculated. Bivariate and multivariate analysis identified associations between perioperative variables and complications, as well as relationship to hospital length of stay.
Results: Sixty-seven men and 43 women with a median age of 71, body mass index of 29, estimated glomerular filtration rate (eGFR) of 64 mL/min/1.73 m², and Charlson score of 4 were included. Seventy-five percent underwent a minimally invasive RNU, 47% had a lymph node dissection, and 7% received neoadjuvant chemotherapy. Median hospital length of stay was 4 days (range, 2-22). Overall, 39 patients (35%) experienced a total of 56 complications including 12 major (≥ Clavien III) and 44 minor. Median CCI patients with complications cohort was 20.9 (range, 8.7-100). The upper quartile of CCI (> 75th %) was associated with higher Charlson score (p = 0.03), lower baseline eGFR (p = 0.005), intraoperative transfusion (p = 0.004), and absence of symptoms at presentation (p = 0.015). Major CD complications were associated with these same variables. On multivariate analysis, only the upper quartile of CCI was associated with length of stay (8.25 versus 5.61 days, p < 0.0001) whilst major CD complications were not (7.98 versus 6.32, p = 0.211).
Conclusions: The CCI and CD classification schemes are both associated with similar baseline and perioperative characteristics for RNU patients. However, the cumulative nature of CCI appears to permit more accurate prediction of length of stay following surgery compared to the CD system.